Provider Demographics
NPI:1033627120
Name:AEMS
Entity Type:Organization
Organization Name:AEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:208-731-7319
Mailing Address - Street 1:279 CLIFF LN
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-5435
Mailing Address - Country:US
Mailing Address - Phone:208-731-7319
Mailing Address - Fax:
Practice Address - Street 1:197 BAKER STREET
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:NV
Practice Address - Zip Code:89835
Practice Address - Country:US
Practice Address - Phone:775-738-3000
Practice Address - Fax:775-738-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA-1661261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1609969443Medicaid