Provider Demographics
NPI:1437333895
Name:INA AMBER MD LLC
Entity Type:Organization
Organization Name:INA AMBER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRIVATE PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:INA
Authorized Official - Middle Name:J
Authorized Official - Last Name:AMBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-268-6830
Mailing Address - Street 1:1151 E 3900 SO
Mailing Address - Street 2:SUITE B275
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124
Mailing Address - Country:US
Mailing Address - Phone:801-268-6830
Mailing Address - Fax:801-262-3584
Practice Address - Street 1:1151 E 3900 SO
Practice Address - Street 2:SUITE B275
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124
Practice Address - Country:US
Practice Address - Phone:801-268-6830
Practice Address - Fax:801-262-3584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1717901205207RI0200X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1760549927OtherINIVIDUAL NPI
UT366482338051Medicaid
UT000057399Medicare PIN
UT366482338051Medicaid