MEDICARE: FIRST CHOICE OCCUPATIONAL MEDICINE AND DISABILITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0901X	Public Health & General Preventive Medicine Physician	32579	WI

General Provider Information

NPI Number	:	1972891661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE OCCUPATIONAL MEDICINE AND DISABILITY

Provider Business Mailing Address
First Line	:	2715 W FRANK ST
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54703-2593
Country	:	US
Telephone Number	:	715-832-0707
Fax Number	:	715-834-5870

Provider Business Practice Location Address
First Line	:	1125 BROADWAY ST N STE 3
Second Line	:
City	:	MENOMONIE
State	:	WI
Zip	:	54751-1579
Country	:	US
Telephone Number	:	715-235-2667
Fax Number	:

Authorized Official
Title or Position	:	BILLING
Name	:	MICHELLE R SESSIONS
Credential	:
Telephone Number	:	715-832-0707

Provider Enumeration Date	:	07/14/2011
Last Update Date	:	07/14/2011

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