Provider Demographics
NPI:1700810629
Name:AMBUMED INC.
Entity Type:Organization
Organization Name:AMBUMED INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:COLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-851-5099
Mailing Address - Street 1:77 CALLE PORTAL
Mailing Address - Street 2:STE B260-A
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635
Mailing Address - Country:US
Mailing Address - Phone:520-226-4338
Mailing Address - Fax:520-335-8705
Practice Address - Street 1:803 BARKWOOD COURT
Practice Address - Street 2:STE A
Practice Address - City:LINTHICUM HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:21090
Practice Address - Country:US
Practice Address - Phone:800-551-4354
Practice Address - Fax:410-442-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2332281 00Medicaid
MDFMVC04Medicare UPIN