Healthcare Provider Details

I. General information

NPI: 1285755181
Provider Name (Legal Business Name): WORKWELL INDUSTRIAL MEDICINE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W UNIVERSITY ST
SILOAM SPRINGS AR
72761-2663
US

IV. Provider business mailing address

101 W UNIVERSITY ST
SILOAM SPRINGS AR
72761-2663
US

V. Phone/Fax

Practice location:
  • Phone: 479-524-8552
  • Fax: 479-524-8593
Mailing address:
  • Phone: 479-524-8552
  • Fax: 479-524-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberON8070
License Number StateAR

VIII. Authorized Official

Name: MRS. MICHELLE G. RYAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 479-524-8552