Provider Demographics
NPI:1902269889
Name:COMMUNITY OCCUPATIONAL MEDICINE, LLC
Entity type:Organization
Organization Name:COMMUNITY OCCUPATIONAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:574-389-1231
Mailing Address - Street 1:22818 OLD US 20
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9150
Mailing Address - Country:US
Mailing Address - Phone:574-389-1231
Mailing Address - Fax:574-389-1232
Practice Address - Street 1:22818 OLD US 20
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9150
Practice Address - Country:US
Practice Address - Phone:574-389-1231
Practice Address - Fax:574-389-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28193462A261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine