MEDICARE: WORKWELL INDUSTRIAL MEDICINE CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	ON8070	AR

General Provider Information

NPI Number	:	1285755181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WORKWELL INDUSTRIAL MEDICINE CLINIC

Provider Business Mailing Address
First Line	:	101 W UNIVERSITY ST
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-2663
Country	:	US
Telephone Number	:	479-524-8552
Fax Number	:	479-524-8593

Provider Business Practice Location Address
First Line	:	101 W UNIVERSITY ST
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-2663
Country	:	US
Telephone Number	:	479-524-8552
Fax Number	:	479-524-8593

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MICHELLE G. RYAN
Credential	:
Telephone Number	:	479-524-8552

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	08/22/2020

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