Provider Demographics
NPI:1578898706
Name:AMBERG, EDWARD A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:A
Last Name:AMBERG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859
Mailing Address - Country:US
Mailing Address - Phone:406-826-4800
Mailing Address - Fax:406-826-4883
Practice Address - Street 1:10 KRUGER RD
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:MT
Practice Address - Zip Code:59859
Practice Address - Country:US
Practice Address - Phone:406-826-4800
Practice Address - Fax:406-828-4883
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT584363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical