Provider Demographics
NPI:1003209347
Name:OCCUPATIONAL MEDICINE ASSOCIATES OF WAYNE COUNTY, INC
Entity Type:Organization
Organization Name:OCCUPATIONAL MEDICINE ASSOCIATES OF WAYNE COUNTY, INC
Other - Org Name:MEDPRO GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANDORSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:330-263-7270
Mailing Address - Street 1:2201 BENDEN DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-5355
Mailing Address - Country:US
Mailing Address - Phone:330-263-7270
Mailing Address - Fax:330-263-7283
Practice Address - Street 1:2201 BENDEN DR
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-5355
Practice Address - Country:US
Practice Address - Phone:330-263-7270
Practice Address - Fax:330-263-7283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine