Provider Demographics
NPI:1730183385
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:SUITE 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 1:1301 E ARAPAHO RD
Practice Address - Street 2:SUITE 103
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2497
Practice Address - Country:US
Practice Address - Phone:214-828-9848
Practice Address - Fax:214-828-9508
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBER ACQUISITION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-10
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
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
2093431OtherPK
TX11130402Medicaid
TX11130402Medicaid