Provider Demographics
NPI:1750833661
Name:AMBULATORY CARE PHYSICIANS
Entity Type:Organization
Organization Name:AMBULATORY CARE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMERGENCY MEDICINE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-582-5299
Mailing Address - Street 1:304 CITY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2511
Mailing Address - Country:US
Mailing Address - Phone:413-896-4620
Mailing Address - Fax:
Practice Address - Street 1:30 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2052
Practice Address - Country:US
Practice Address - Phone:413-582-2363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOLEY DICKINSON HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5932261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care