Basic Information
| Provider Information | |||||||||
| NPI: | 1750833661 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMBULATORY CARE PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 304 CITY VIEW AVE | ||||||||
| Address2: | |||||||||
| City: | WEST SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010892511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4138964620 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135822363 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2016 | ||||||||
| LastUpdateDate: | 10/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | ENNIS | ||||||||
| AuthorizedOfficialFirstName: | KHAMA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EMERGENCY MEDICINE PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4135825299 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COOLEY DICKINSON HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | PA5932 | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No ID Information.