Provider Demographics
NPI:1285755181
Name:WORKWELL INDUSTRIAL MEDICINE CLINIC
Entity type:Organization
Organization Name:WORKWELL INDUSTRIAL MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-524-8552
Mailing Address - Street 1:101 W UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-2663
Mailing Address - Country:US
Mailing Address - Phone:479-524-8552
Mailing Address - Fax:479-524-8593
Practice Address - Street 1:101 W UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-2663
Practice Address - Country:US
Practice Address - Phone:479-524-8552
Practice Address - Fax:479-524-8593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARON80702083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARB65078Medicare UPIN