Basic Information
| Provider Information | |||||||||
| NPI: | 1689806689 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXIGENCE OF FREMONT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 JOHN JAMES AUDUBON PKWY | ||||||||
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| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142281143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162044500 | ||||||||
| FaxNumber: | 7162044501 | ||||||||
| Practice Location | |||||||||
| Address1: | 715 S TAFT AVE | ||||||||
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| City: | FREMONT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434203200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193327321 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2009 | ||||||||
| LastUpdateDate: | 05/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | HOLTZCLAW | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8566864317 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.