Basic Information
| Provider Information | |||||||||
| NPI: | 1750479150 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AXIOM OCCUPATIONAL HEALTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 19999 | ||||||||
| Address2: | |||||||||
| City: | JOHNSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029190999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016162000 | ||||||||
| FaxNumber: | 4016162001 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 SMITHFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028603497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013120545 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCLOY | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4013120545 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | 5160 | RI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.