Provider Demographics
NPI:1053583559
Name:AMBIENT MEDICAL CARE, LLC
Entity type:Organization
Organization Name:AMBIENT MEDICAL CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-629-3099
Mailing Address - Street 1:PO BOX 1827
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-8827
Mailing Address - Country:US
Mailing Address - Phone:302-629-3099
Mailing Address - Fax:302-629-6059
Practice Address - Street 1:24459 SUSSEX HWY STE 2
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-4425
Practice Address - Country:US
Practice Address - Phone:302-629-3099
Practice Address - Fax:302-629-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE13127Medicare PIN
DE6413690001Medicare NSC