Provider Demographics
NPI:1740773753
Name:AMS MEDICAL GROUP
Entity Type:Organization
Organization Name:AMS MEDICAL GROUP
Other - Org Name:AMS MEDICAL GROUP OF WINTER GARDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NIDIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-750-8750
Mailing Address - Street 1:736 S DILLARD ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3908
Mailing Address - Country:US
Mailing Address - Phone:407-395-9557
Mailing Address - Fax:
Practice Address - Street 1:736 S DILLARD ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3908
Practice Address - Country:US
Practice Address - Phone:407-395-9557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMS MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty