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General NPI Number Information
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NPI Number | 1003137134
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Entity Type | Organization
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Legal Business Name | WORKWELL OCCUPATIONAL MEDICINE
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 205 S MAIN ST
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City | LONGMONT
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State | CO
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Zip | 80501-1716
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Country | US
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Telephone | 303-702-1612
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Fax |
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Provider Business Mailing Address
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Address Line | 205 S MAIN ST
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City | LONGMONT
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State | CO
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Zip | 80501-1716
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Country | US
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Telephone | 303-702-1612
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. BRIAN MATHWICH
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Credential |
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Telephone | 303-702-1612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | PTL.0011880
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License Number State | CO
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