Provider Demographics
NPI:1003150004
Name:AMS OF WISCONSIN, LLC
Entity Type:Organization
Organization Name:AMS OF WISCONSIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ERRICO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:608-783-0506
Mailing Address - Street 1:9532 E 16 FRONTAGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-6739
Mailing Address - Country:US
Mailing Address - Phone:608-783-0506
Mailing Address - Fax:608-783-0242
Practice Address - Street 1:9532 E 16 FRONTAGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-6739
Practice Address - Country:US
Practice Address - Phone:608-783-0506
Practice Address - Fax:608-783-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2971261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone