Provider Demographics
NPI:1417407552
Name:RICK'S AMT LLC
Entity Type:Organization
Organization Name:RICK'S AMT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-738-6202
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:PORT AUSTIN
Mailing Address - State:MI
Mailing Address - Zip Code:48467-0339
Mailing Address - Country:US
Mailing Address - Phone:989-738-6202
Mailing Address - Fax:
Practice Address - Street 1:108 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:PORT AUSTIN
Practice Address - State:MI
Practice Address - Zip Code:48467-6720
Practice Address - Country:US
Practice Address - Phone:989-738-6202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMDOT 1005347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle