=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588728240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORION EMERGENCY SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 05/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 PROSPECT ST
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01757-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-422-2250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 OLD BROOK RD
-----------------------------------------------------
City | SHREWSBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01545-5409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-845-0127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARY C. BURKE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 508-845-0127
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------