Healthcare Provider Details

I. General information

NPI: 1689806689
Provider Name (Legal Business Name): EXIGENCE OF FREMONT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S TAFT AVE
FREMONT OH
43420-3200
US

IV. Provider business mailing address

1 JOHN JAMES AUDUBON PKWY
AMHERST NY
14228-1143
US

V. Phone/Fax

Practice location:
  • Phone: 419-332-7321
  • Fax:
Mailing address:
  • Phone: 716-204-4500
  • Fax: 716-204-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHEN G HOLTZCLAW
Title or Position: OWNER
Credential: MD
Phone: 856-686-4317