Provider Demographics
NPI:1609244508
Name:AMBERWELL ATCHISON ASSOCIATION
Entity Type:Organization
Organization Name:AMBERWELL ATCHISON ASSOCIATION
Other - Org Name:AMBERWELL OCCUPATIONAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF CLINICS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BROCKHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:ATC-L, CPTA
Authorized Official - Phone:913-360-5829
Mailing Address - Street 1:820 RAVENHILL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-9268
Mailing Address - Country:US
Mailing Address - Phone:913-360-5829
Mailing Address - Fax:913-674-2040
Practice Address - Street 1:820 RAVENHILL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-9268
Practice Address - Country:US
Practice Address - Phone:913-360-5829
Practice Address - Fax:913-674-2040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBERWELL ATCHISON ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-09
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH-003-0012083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty