1427067388 NPI number — A M M S INC

Table of content: (NPI 1427067388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427067388 NPI number — A M M S INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A M M S INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427067388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2289
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE SALMON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98672-2289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-493-1467
Provider Business Mailing Address Fax Number:
509-493-3765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
648 CHETCO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKINGS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-412-9804
Provider Business Practice Location Address Fax Number:
541-469-4187
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TATE
Authorized Official First Name:
CAROLANN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
509-493-1467

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H1180 . This is a "PACIFIC SOURCE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 029072 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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