Provider Demographics
NPI:1841209913
Name:A M M S INC
Entity Type:Organization
Organization Name:A M M S INC
Other - Org Name:EMERALD ANESTHESIA SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCHALESASS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:541-689-0864
Mailing Address - Street 1:400 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:952-442-3603
Mailing Address - Fax:952-442-3672
Practice Address - Street 1:12050 SE STEVENS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97086-7667
Practice Address - Country:US
Practice Address - Phone:952-442-3603
Practice Address - Fax:952-442-3672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR029072Medicaid
OR825658000OtherREGENCE BCBSO
ORDC1444OtherPALMETTO GBA-RAILROAD MC
ORH1180OtherPACIFIC SOURCE
OR029072Medicaid
OR118164Medicare ID - Type Unspecified