Healthcare Provider Details

I. General information

NPI: 1639587710
Provider Name (Legal Business Name): OCCUPATIONAL MEDICINE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 VALHI LAGOON XING
HOUMA LA
70360-3208
US

IV. Provider business mailing address

144 VALHI LAGOON XING
HOUMA LA
70360-3208
US

V. Phone/Fax

Practice location:
  • Phone: 985-223-0032
  • Fax:
Mailing address:
  • Phone: 985-223-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number014511
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANN ROME
Title or Position: ADMINISTRATOR
Credential:
Phone: 985-223-0032