Provider Demographics
NPI:1720513013
Name:AMBERMED, LLC
Entity type:Organization
Organization Name:AMBERMED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BAKERINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-743-2229
Mailing Address - Street 1:414 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50849-1444
Mailing Address - Country:US
Mailing Address - Phone:844-946-8869
Mailing Address - Fax:
Practice Address - Street 1:414 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IA
Practice Address - Zip Code:50849-1444
Practice Address - Country:US
Practice Address - Phone:844-946-8869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service