Basic Information
| Provider Information | |||||||||
| NPI: | 1003137134 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WORKWELL OCCUPATIONAL MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805011716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037021612 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805011716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037021612 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2010 | ||||||||
| LastUpdateDate: | 04/23/2013 | ||||||||
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| AuthorizedOfficialLastName: | MATHWICH | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 3037021612 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X | PTL.0011880 | CO | Y | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
No ID Information.