Healthcare Provider Details

I. General information

NPI: 1558800532
Provider Name (Legal Business Name): AMS OHIO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 N PALAFOX ST
PENSACOLA FL
32502-5626
US

IV. Provider business mailing address

PO BOX 6149
SPRINGFIELD IL
62708-6149
US

V. Phone/Fax

Practice location:
  • Phone: 866-653-2540
  • Fax: 941-358-9818
Mailing address:
  • Phone: 866-653-2540
  • Fax: 941-269-4451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateOH

VIII. Authorized Official

Name: DAVID SIMPSON
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 866-653-2540