MEDICARE: U.S. HEALTHWORKS MEDICAL GROUP OF INDIANA, PC

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	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1588113625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	U.S. HEALTHWORKS MEDICAL GROUP OF INDIANA, PC

Provider Business Mailing Address
First Line	:	25124 SPRINGFIELD CT
Second Line	:	SUITE 200
City	:	VALENCIA
State	:	CA
Zip	:	91355-1085
Country	:	US
Telephone Number	:	661-678-2600
Fax Number	:	661-678-2700

Provider Business Practice Location Address
First Line	:	2014 LINCOLNWAY E
Second Line	:
City	:	GOSHEN
State	:	IN
Zip	:	46526-6818
Country	:	US
Telephone Number	:	574-537-1709
Fax Number	:	574-537-1736

Authorized Official
Title or Position	:	PRESIDENT & CHIEF EXECUTIVE OFFICER
Name	:	MR. JOSEPH T MALLAS
Credential	:
Telephone Number	:	661-678-2600

Provider Enumeration Date	:	09/30/2016
Last Update Date	:	09/30/2016

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