Basic Information
| Provider Information | |||||||||
| NPI: | 1659621043 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ONSITE OCCUPATIONAL HEALTH & SAFETY, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ONSITE OHS INTERNATIONAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3276 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477313276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124911328 | ||||||||
| FaxNumber: | 8124926328 | ||||||||
| Practice Location | |||||||||
| Address1: | FOB SHARANA BUILDING 660 | ||||||||
| Address2: | |||||||||
| City: | SHARANA | ||||||||
| State: | AFGHANISTAN | ||||||||
| PostalCode: | 09311 | ||||||||
| CountryCode: | AF | ||||||||
| TelephoneNumber: | 9314724398 | ||||||||
| FaxNumber: | 8124735822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2012 | ||||||||
| LastUpdateDate: | 09/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | KYLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8123858306 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ONSITE OCCUPATIONAL HEALTH & SAFETY, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.