Basic Information
| Provider Information | |||||||||
| NPI: | 1851530760 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AMBULATORY EMPLOYEE INDUSTRIAL OCCUPATIONAL AND URGENT HEALTHCARE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AEIOU HEALTHCARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 170 UNIVERSITY DRIVE | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010022247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133874556 | ||||||||
| FaxNumber: | 4134613532 | ||||||||
| Practice Location | |||||||||
| Address1: | 170 UNIVERSITY DRIVE | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010022247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133874556 | ||||||||
| FaxNumber: | 4134613532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2009 | ||||||||
| LastUpdateDate: | 02/24/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CONWAY | ||||||||
| AuthorizedOfficialFirstName: | RAYMOND | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4133874556 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.