Healthcare Provider Details

I. General information

NPI: 1154378750
Provider Name (Legal Business Name): OCCUPATIONAL MEDICINE ASSOCIATES PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E SECOND AVENUE SUITE 102
SPOKANE WA
99202
US

IV. Provider business mailing address

323 E SECOND AVENUE SUITE 102
SPOKANE WA
99202
US

V. Phone/Fax

Practice location:
  • Phone: 509-455-5555
  • Fax: 509-455-4114
Mailing address:
  • Phone: 509-455-5555
  • Fax: 509-455-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAULA A LANTSBERGER
Title or Position: PHYSICIAN OWNER
Credential: MD MPH FACOEM
Phone: 509-455-5555