=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053583559
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMBIENT MEDICAL CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2008
-----------------------------------------------------
Last Update Date | 04/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24459 SUSSEX HWY STE 2
-----------------------------------------------------
City | SEAFORD
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19973-4425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-629-3099
-----------------------------------------------------
Fax | 302-629-6059
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1827
-----------------------------------------------------
City | SEAFORD
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19973-8827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-629-3099
-----------------------------------------------------
Fax | 302-629-6059
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | ROBERT ANTHONY HENRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 302-629-3099
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------