Provider Demographics
NPI:1609015569
Name:OCCUPATIONAL HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:OCCUPATIONAL HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:KISER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-265-8829
Mailing Address - Street 1:2688 VISSERS CT
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-5856
Mailing Address - Country:US
Mailing Address - Phone:920-265-8829
Mailing Address - Fax:920-498-8829
Practice Address - Street 1:2688 VISSERS CT
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-5856
Practice Address - Country:US
Practice Address - Phone:920-265-8829
Practice Address - Fax:920-498-8829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23110251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000086811OtherMEDICARE PROVIDER NUMBER