Provider Demographics
NPI:1346661196
Name:LANDMARK OCCUPATIONAL HEALTH, P.C.
Entity Type:Organization
Organization Name:LANDMARK OCCUPATIONAL HEALTH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HIGHTOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-774-3541
Mailing Address - Street 1:310 AIRPORT RD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-2959
Mailing Address - Country:US
Mailing Address - Phone:701-774-3541
Mailing Address - Fax:701-774-3543
Practice Address - Street 1:310 AIRPORT RD STE 2000
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-2959
Practice Address - Country:US
Practice Address - Phone:701-774-3541
Practice Address - Fax:701-774-3543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND12175261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F11539Medicare UPIN