Healthcare Provider Details

I. General information

NPI: 1942545546
Provider Name (Legal Business Name): AMR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6096 E MAIN ST STE 103
COLUMBUS OH
43213-4302
US

IV. Provider business mailing address

6096 E MAIN ST STE 103
COLUMBUS OH
43213-4302
US

V. Phone/Fax

Practice location:
  • Phone: 614-751-1500
  • Fax: 614-751-1501
Mailing address:
  • Phone: 614-751-1500
  • Fax: 614-751-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number2084P0800X
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberE 0007908
License Number StateOH

VIII. Authorized Official

Name: DR. KHALED L AMR
Title or Position: OWNER/INDEPENDENT
Credential: MD
Phone: 614-751-1500