Provider Demographics
NPI:1821200528
Name:OCCUPATIONAL MEDICINE AND INJURY CLINIC
Entity Type:Organization
Organization Name:OCCUPATIONAL MEDICINE AND INJURY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-463-8900
Mailing Address - Street 1:6870 W 52ND AVE
Mailing Address - Street 2:201
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-3951
Mailing Address - Country:US
Mailing Address - Phone:303-463-8900
Mailing Address - Fax:303-463-0110
Practice Address - Street 1:6870 W 52ND AVE
Practice Address - Street 2:201
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-3951
Practice Address - Country:US
Practice Address - Phone:303-463-8900
Practice Address - Fax:303-463-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26628261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1750398210OtherNPI