Provider Demographics
NPI:1578695250
Name:COMMUNITY OCCUPATIONAL MEDICINE
Entity Type:Organization
Organization Name:COMMUNITY OCCUPATIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:J
Authorized Official - Last Name:NYMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
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:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center