| Organization Name: | AMS OF WISCONSIN, LLC |
| NPI Number: | 1003150004 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL ERRICO (PRESIDENT) |
| Mailing Address: | 9532 E 16 Frontage Rd Suite 100 Onalaska |
| State: | WI US |
| Postal Code: | 546506739 |
| Phone Number: | 6087830506 |
| Fax Number: | 6087830242 |
| NPI Enumeration Date: | 11/15/2012 |
| NPI Last Update Date: | 11/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM2800X |
| License Number: | 2971 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Methadone Clinic |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. |