Provider Demographics
NPI:1679586259
Name:CONTRA COSTA INDUSTRIAL MEDICINE CLINIC
Entity Type:Organization
Organization Name:CONTRA COSTA INDUSTRIAL MEDICINE CLINIC
Other - Org Name:CONTRA COSTA INDUSTRIAL MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:925-777-9194
Mailing Address - Street 1:120 BROADWAY AVE
Mailing Address - Street 2:STE 23
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804
Mailing Address - Country:US
Mailing Address - Phone:510-236-7243
Mailing Address - Fax:510-232-1411
Practice Address - Street 1:2339 BUCHANAN RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4402
Practice Address - Country:US
Practice Address - Phone:925-777-9194
Practice Address - Fax:925-777-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine