Provider Demographics
NPI:1154378750
Name:OCCUPATIONAL MEDICINE ASSOCIATES PS
Entity type:Organization
Organization Name:OCCUPATIONAL MEDICINE ASSOCIATES PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANTSBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH FACOEM
Authorized Official - Phone:509-455-5555
Mailing Address - Street 1:323 E SECOND AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202
Mailing Address - Country:US
Mailing Address - Phone:509-455-5555
Mailing Address - Fax:509-455-4114
Practice Address - Street 1:323 E SECOND AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-455-5555
Practice Address - Fax:509-455-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine