Provider Demographics
NPI:1760625917
Name:COMPREHENSIVE OCCUPATIONAL MED ASOC OF CONNECTICUT,PC
Entity Type:Organization
Organization Name:COMPREHENSIVE OCCUPATIONAL MED ASOC OF CONNECTICUT,PC
Other - Org Name:SPRINT ON SITE HEALTH CENTER RESTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPRCIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-468-6548
Mailing Address - Street 1:12000 SUNRISE VALLEY DR BLDG E
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3403
Mailing Address - Country:US
Mailing Address - Phone:703-592-7111
Mailing Address - Fax:
Practice Address - Street 1:12000 SUNRISE VALLEY DR BLDG E
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3403
Practice Address - Country:US
Practice Address - Phone:615-468-6548
Practice Address - Fax:615-468-0477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care