Healthcare Provider Details

I. General information

NPI: 1457983462
Provider Name (Legal Business Name): AMH SERIES II ID, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 E OVERLAND RD STE 1E
MERIDIAN ID
83642-9005
US

IV. Provider business mailing address

3875 E OVERLAND RD STE 105
MERIDIAN ID
83642-9047
US

V. Phone/Fax

Practice location:
  • Phone: 901-757-5783
  • Fax:
Mailing address:
  • Phone: 208-268-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA WILKINSON
Title or Position: BUSINESS OPERATIONS DIRECTOR
Credential:
Phone: 702-818-0446