Provider Demographics
NPI:1851530760
Name:AMBULATORY EMPLOYEE INDUSTRIAL OCCUPATIONAL AND URGENT HEALTHCARE
Entity Type:Organization
Organization Name:AMBULATORY EMPLOYEE INDUSTRIAL OCCUPATIONAL AND URGENT HEALTHCARE
Other - Org Name:AEIOU HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:F
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-387-4556
Mailing Address - Street 1:170 UNIVERSITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2247
Mailing Address - Country:US
Mailing Address - Phone:413-387-4556
Mailing Address - Fax:413-461-3532
Practice Address - Street 1:170 UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2247
Practice Address - Country:US
Practice Address - Phone:413-387-4556
Practice Address - Fax:413-461-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0014188Medicare PIN