Healthcare Provider Details

I. General information

NPI: 1972834067
Provider Name (Legal Business Name): WORKPLACE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 CENTURY PLAZA RD STE 140
INDIANAPOLIS IN
46254-5478
US

IV. Provider business mailing address

4850 CENTURY PLAZA RD STE 140
INDIANAPOLIS IN
46254-5478
US

V. Phone/Fax

Practice location:
  • Phone: 317-216-2828
  • Fax: 317-216-2839
Mailing address:
  • Phone: 317-216-2828
  • Fax: 317-216-2839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS BRINK
Title or Position: CEO
Credential:
Phone: 317-216-2520