Healthcare Provider Details

I. General information

NPI: 1063864080
Provider Name (Legal Business Name): AMBIENT MEDICAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2016
Last Update Date: 07/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MIDWAY DR SUITE 11B
HARRINGTON DE
19952-2448
US

IV. Provider business mailing address

1000 MIDWAY DR SUITE 11B
HARRINGTON DE
19952-2448
US

V. Phone/Fax

Practice location:
  • Phone: 302-629-3099
  • Fax:
Mailing address:
  • Phone: 302-629-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number2016604668
License Number StateDE

VIII. Authorized Official

Name: ROBERT HENRY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 410-603-8457