Provider Demographics
NPI:1376981555
Name:COMPREHENSIVE OCCUPATIONAL MEDICINE PARTNERS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:COMPREHENSIVE OCCUPATIONAL MEDICINE PARTNERS MEDICAL GROUP, INC.
Other - Org Name:PREMIER COMP MEDICAL GROUP, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY, CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:DREW-NORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ANP, BC
Authorized Official - Phone:925-520-0055
Mailing Address - Street 1:5635 W LAS POSITAS BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8538
Mailing Address - Country:US
Mailing Address - Phone:925-520-0055
Mailing Address - Fax:925-520-0099
Practice Address - Street 1:5635 W LAS POSITAS BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8538
Practice Address - Country:US
Practice Address - Phone:925-520-0055
Practice Address - Fax:925-520-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36135261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine