1841209913 NPI number — A M M S INC

Table of content: (NPI 1841209913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841209913 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:
1841209913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 E 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACONIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55387-4552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-442-3603
Provider Business Mailing Address Fax Number:
952-442-3672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12050 SE STEVENS RD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97086-7667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-442-3603
Provider Business Practice Location Address Fax Number:
952-442-3672
Provider Enumeration Date:
08/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCHALESASS
Authorized Official First Name:
ANN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
541-689-0864

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: 029072 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 825658000 . This is a "REGENCE BCBSO" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: DC1444 . This is a "PALMETTO GBA-RAILROAD MC" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: H1180 . This is a "PACIFIC SOURCE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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