Healthcare Provider Details

I. General information

NPI: 1649407131
Provider Name (Legal Business Name): AMHERST COLON & RECTAL SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 MAIN ST SUITE 8
WILLIAMSVILLE NY
14221-6046
US

IV. Provider business mailing address

8201 MAIN ST SUITE 8
WILLIAMSVILLE NY
14221-6046
US

V. Phone/Fax

Practice location:
  • Phone: 716-626-6626
  • Fax: 716-626-6646
Mailing address:
  • Phone: 716-626-6626
  • Fax: 716-626-6646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number130603
License Number StateNY

VIII. Authorized Official

Name: DR. FRED E BOEHMKE
Title or Position: SOLE MEMBER
Credential: MD
Phone: 716-626-6626