Basic Information
| Provider Information | |||||||||
| NPI: | 1841368537 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INJURY CONTROL SYSTEMS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PACIFIC OCCUPATIONAL HEALTH CLINIC POHC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 SOUTH LINDEN AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505892647 | ||||||||
| FaxNumber: | 6505835549 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 SOUTH LINDEN AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505892647 | ||||||||
| FaxNumber: | 6505835549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SKINNER | ||||||||
| AuthorizedOfficialFirstName: | MATT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6505892647 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.