Provider Demographics
NPI:1235395724
Name:WORKERS' COMPENSATION MEDICAL CONSULTING, LC
Entity type:Organization
Organization Name:WORKERS' COMPENSATION MEDICAL CONSULTING, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOLLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS, CIME
Authorized Official - Phone:636-730-3177
Mailing Address - Street 1:16282 AUDUBON VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1710
Mailing Address - Country:US
Mailing Address - Phone:314-302-0623
Mailing Address - Fax:
Practice Address - Street 1:2638 HIGHWAY 109
Practice Address - Street 2:SUITE 101
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1161
Practice Address - Country:US
Practice Address - Phone:636-730-3177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9N85261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine