Provider Demographics
NPI:1558452276
Name:AMBER ENTERPRISES INC
Entity type:Organization
Organization Name:AMBER ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-267-2800
Mailing Address - Street 1:10004 S 152ND ST
Mailing Address - Street 2:STE A
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138-3930
Mailing Address - Country:US
Mailing Address - Phone:402-896-5000
Mailing Address - Fax:402-896-3774
Practice Address - Street 1:1 E ERIE ST STE 630
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4756
Practice Address - Country:US
Practice Address - Phone:312-337-7750
Practice Address - Fax:312-337-7760
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBER ACQUISITION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-27
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336S0011X, 3336C0004X, 3336H0001X, 3336S0011X
IL0540186563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2023264OtherPK
IL=========002Medicaid
0297920007Medicare NSC