Provider Demographics
NPI:1972519213
Name:VICK, AMBER O (MD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:O
Last Name:VICK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:600 PETERSON PARKWAY
Mailing Address - Street 2:AFFILIATED COMMUNITY MEDICAL CENTERS
Mailing Address - City:NEW LONDON
Mailing Address - State:MN
Mailing Address - Zip Code:56273
Mailing Address - Country:US
Mailing Address - Phone:320-354-2222
Mailing Address - Fax:218-529-9120
Practice Address - Street 1:600 PETERSON PARKWAY
Practice Address - Street 2:AFFILIATED COMMUNITY MEDICAL CENTERS
Practice Address - City:NEW LONDON
Practice Address - State:MN
Practice Address - Zip Code:56273
Practice Address - Country:US
Practice Address - Phone:320-354-2222
Practice Address - Fax:218-529-9120
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-04-12
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Provider Licenses
StateLicense IDTaxonomies
MN48788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01-25488OtherMEDICA
MN165H7HOOtherBCBSMN
P00442141OtherRR MEDICARE PTAN
MN985172000Medicaid
P00442141OtherRR MEDICARE PTAN
MN985172000Medicaid