Provider Demographics
NPI:1386678159
Name:REISS-HOLT, AMBER C
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:C
Last Name:REISS-HOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:C
Other - Last Name:REISS-HOLT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:27 TALISMAN DR
Mailing Address - Street 2:STE 3
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-9377
Mailing Address - Country:US
Mailing Address - Phone:970-372-0456
Mailing Address - Fax:
Practice Address - Street 1:27 TALISMAN DR
Practice Address - Street 2:STE 3
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-9377
Practice Address - Country:US
Practice Address - Phone:970-372-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49984207P00000X, 208600000X, 2086S0102X, 208D00000X
NMMD2023-11122086S0102X
CAA830632086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM70450846Medicaid
CO24070394Medicaid
CO24070394Medicaid
CO318119YLKWMedicare PIN