Healthcare Provider Details

I. General information

NPI: 1891911632
Provider Name (Legal Business Name): OCCUPATIONAL HEALTH NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E COLORADO BLVD
SPEARFISH SD
57783-2776
US

IV. Provider business mailing address

550 E COLORADO BLVD
SPEARFISH SD
57783-2776
US

V. Phone/Fax

Practice location:
  • Phone: 605-642-2030
  • Fax:
Mailing address:
  • Phone: 605-642-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number1344
License Number StateSD

VIII. Authorized Official

Name: WAYNE J ANDERSON
Title or Position: PRESIDENT
Credential: MD
Phone: 605-642-2030