Healthcare Provider Details

I. General information

NPI: 1750479150
Provider Name (Legal Business Name): AXIOM OCCUPATIONAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SMITHFIELD AVE
PAWTUCKET RI
02860-3497
US

IV. Provider business mailing address

PO BOX 19999
JOHNSTON RI
02919-0999
US

V. Phone/Fax

Practice location:
  • Phone: 401-312-0545
  • Fax:
Mailing address:
  • Phone: 401-616-2000
  • Fax: 401-616-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number5160
License Number StateRI

VIII. Authorized Official

Name: DR. STEVEN G MCCLOY
Title or Position: PHYSICIAN
Credential: MD
Phone: 401-312-0545