Provider Demographics
NPI:1639587710
Name:OCCUPATIONAL MEDICINE SERVICES LLC
Entity Type:Organization
Organization Name:OCCUPATIONAL MEDICINE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-223-0032
Mailing Address - Street 1:144 VALHI LAGOON XING
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3208
Mailing Address - Country:US
Mailing Address - Phone:985-223-0032
Mailing Address - Fax:
Practice Address - Street 1:144 VALHI LAGOON XING
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3208
Practice Address - Country:US
Practice Address - Phone:985-223-0032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014511174400000X
261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Single Specialty