Provider Demographics
NPI:1528064540
Name:AME
Entity type:Organization
Organization Name:AME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KICKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-525-1539
Mailing Address - Street 1:311 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:NE
Mailing Address - Zip Code:69154-6112
Mailing Address - Country:US
Mailing Address - Phone:308-772-3333
Mailing Address - Fax:308-772-0126
Practice Address - Street 1:311 MAIN ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:NE
Practice Address - Zip Code:69154-6112
Practice Address - Country:US
Practice Address - Phone:308-772-3333
Practice Address - Fax:308-772-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE29223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39198427300Medicaid
2134192OtherPK
3995630001Medicare NSC