Healthcare Provider Details

I. General information

NPI: 1346661196
Provider Name (Legal Business Name): LANDMARK OCCUPATIONAL HEALTH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 AIRPORT RD STE 2000
WILLISTON ND
58801-2959
US

IV. Provider business mailing address

310 AIRPORT RD STE 2000
WILLISTON ND
58801-2959
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-3541
  • Fax: 701-774-3543
Mailing address:
  • Phone: 701-774-3541
  • Fax: 701-774-3543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number12175
License Number StateND

VIII. Authorized Official

Name: DR. GEORGE B HIGHTOWER
Title or Position: CEO
Credential: M.D.
Phone: 701-774-3541