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General NPI Number Information
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NPI Number | 1235395724
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Entity Type | Organization
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Legal Business Name | WORKERS' COMPENSATION MEDICAL CONSULTING, LC
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 2638 HIGHWAY 109 SUITE 101
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City | WILDWOOD
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State | MO
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Zip | 63040-1161
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Country | US
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Telephone | 636-730-3177
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Fax |
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Provider Business Mailing Address
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Address Line | 16282 AUDUBON VILLAGE DR
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City | WILDWOOD
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State | MO
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Zip | 63040-1710
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Country | US
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Telephone | 314-302-0623
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY ANN HOLLMAN
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Credential | MD, MS, CIME
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Telephone | 636-730-3177
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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 | R9N85
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License Number State | MO
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