Provider Demographics
NPI:1073022067
Name:COMPREHENSIVE OCC MED PHYSICALS ACAD&SURVEILLANCESOLUTIONSLLC
Entity Type:Organization
Organization Name:COMPREHENSIVE OCC MED PHYSICALS ACAD&SURVEILLANCESOLUTIONSLLC
Other - Org Name:COMPASS OCC MED.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALLICOAT
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, NP-C, MS-ATE
Authorized Official - Phone:681-217-7172
Mailing Address - Street 1:4115 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NITRO
Mailing Address - State:WV
Mailing Address - Zip Code:25143-1304
Mailing Address - Country:US
Mailing Address - Phone:681-217-7172
Mailing Address - Fax:681-217-7106
Practice Address - Street 1:4115 1ST AVE
Practice Address - Street 2:
Practice Address - City:NITRO
Practice Address - State:WV
Practice Address - Zip Code:25143-1304
Practice Address - Country:US
Practice Address - Phone:681-217-7172
Practice Address - Fax:681-217-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-22
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty