MEDICARE: AMBER BAHM FAMILY PRACTICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1366385031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBER BAHM FAMILY PRACTICE LLC

Provider Business Mailing Address
First Line	:	PO BOX 1175
Second Line	:
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-1175
Country	:	US
Telephone Number	:	402-613-1601
Fax Number	:	725-567-0978

Provider Business Practice Location Address
First Line	:	203 S CANDY LN STE 9B
Second Line	:
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-4121
Country	:	US
Telephone Number	:	402-613-1601
Fax Number	:	725-567-0978

Authorized Official
Title or Position	:	OWNER
Name	:	AMBER BAHM
Credential	:	NP
Telephone Number	:	402-613-1601

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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