Provider Demographics
NPI:1114295631
Name:OCCUPATIONAL HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:OCCUPATIONAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA
Authorized Official - Phone:620-357-5643
Mailing Address - Street 1:PO BOX 1697
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-1697
Mailing Address - Country:US
Mailing Address - Phone:620-357-5643
Mailing Address - Fax:
Practice Address - Street 1:601 ATKIN ST
Practice Address - Street 2:
Practice Address - City:JETMORE
Practice Address - State:KS
Practice Address - Zip Code:67854-9307
Practice Address - Country:US
Practice Address - Phone:620-357-5643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-0602261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine