Provider Demographics
NPI:1952547473
Name:AIR PARK MEDICAL & OCCUPATIONAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:AIR PARK MEDICAL & OCCUPATIONAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRUBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:804-928-8989
Mailing Address - Street 1:11015 LEADBETTER RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-3408
Mailing Address - Country:US
Mailing Address - Phone:804-928-8989
Mailing Address - Fax:804-798-3578
Practice Address - Street 1:11015 LEADBETTER RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-3408
Practice Address - Country:US
Practice Address - Phone:804-928-8989
Practice Address - Fax:804-798-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024100252261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine