Individual
AMBER O VICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 PETERSON PARKWAY, AFFILIATED COMMUNITY MEDICAL CENTERS, NEW LONDON, MN 56273
(320) 354-2222
(218) 529-9120
Mailing address
600 PETERSON PARKWAY, AFFILIATED COMMUNITY MEDICAL CENTERS, NEW LONDON, MN 56273
(320) 354-2222
(218) 529-9120
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
48788
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-25488
MEDICA
MN
01
—
165H7HO
BCBSMN
MN
05
—
985172000
—
MN
01
—
P00442141
RR MEDICARE PTAN
—
Enumeration date
07/31/2006
Last updated
04/12/2011
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