Provider Demographics
NPI:1801339148
Name:SETON OCCUPATIONAL HEALTH CLINIC
Entity type:Organization
Organization Name:SETON OCCUPATIONAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP RISK, OCCUPATIONAL HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:512-324-5654
Mailing Address - Street 1:1345 PHILOMENA ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3210
Mailing Address - Country:US
Mailing Address - Phone:512-324-5650
Mailing Address - Fax:512-406-6547
Practice Address - Street 1:1345 PHILOMENA ST
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3210
Practice Address - Country:US
Practice Address - Phone:512-324-5650
Practice Address - Fax:512-406-6547
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SETON FAMILY OF HOSPITALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine