Healthcare Provider Details

I. General information

NPI: 1851530760
Provider Name (Legal Business Name): AMBULATORY EMPLOYEE INDUSTRIAL OCCUPATIONAL AND URGENT HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 UNIVERSITY DRIVE
AMHERST MA
01002-2247
US

IV. Provider business mailing address

170 UNIVERSITY DRIVE
AMHERST MA
01002-2247
US

V. Phone/Fax

Practice location:
  • Phone: 413-387-4556
  • Fax: 413-461-3532
Mailing address:
  • Phone: 413-387-4556
  • Fax: 413-461-3532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: RAYMOND F CONWAY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 413-387-4556