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General NPI Number Information
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NPI Number | 1649407131
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Entity Type | Organization
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Legal Business Name | AMHERST COLON & RECTAL SURGERY, PLLC
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Dates
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Enumeration Date | 06/11/2009
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Last Update Date | 06/11/2009
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Provider Practice Location Address
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Address Line | 8201 MAIN ST SUITE 8
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-6046
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Country | US
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Telephone | 716-626-6626
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Fax | 716-626-6646
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Provider Business Mailing Address
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Address Line | 8201 MAIN ST SUITE 8
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-6046
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Country | US
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Telephone | 716-626-6626
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Fax | 716-626-6646
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. FRED E BOEHMKE
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Credential | MD
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Telephone | 716-626-6626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 130603
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License Number State | NY
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