Basic Information
| Provider Information | |||||||||
| NPI: | 1942452933 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXIGENCE OF BRADFORD LLC | ||||||||
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| Address1: | 1 JOHN JAMES AUDUBON PKWY | ||||||||
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| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142281143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162044500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 116 INTERSTATE PKWY | ||||||||
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| City: | BRADFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 167011036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162044500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2008 | ||||||||
| 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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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.