Provider Demographics
NPI:1336260421
Name:PROACTIVE WORK HEALTH MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PROACTIVE WORK HEALTH MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-977-9300
Mailing Address - Street 1:1230 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1408
Mailing Address - Country:US
Mailing Address - Phone:213-977-9300
Mailing Address - Fax:213-977-9600
Practice Address - Street 1:1230 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1408
Practice Address - Country:US
Practice Address - Phone:213-977-9300
Practice Address - Fax:213-977-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Not Answered261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Not Answered261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine