Provider Demographics
NPI:1689704801
Name:WORKWELL OCCUPATIONAL MEDICINE
Entity Type:Organization
Organization Name:WORKWELL OCCUPATIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHWICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-702-1612
Mailing Address - Street 1:205 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1716
Mailing Address - Country:US
Mailing Address - Phone:303-702-1612
Mailing Address - Fax:303-774-7899
Practice Address - Street 1:205 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1716
Practice Address - Country:US
Practice Address - Phone:303-702-1612
Practice Address - Fax:303-774-7899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty