Provider Demographics
NPI:1386019057
Name:OCCUMEDICA LLC
Entity Type:Organization
Organization Name:OCCUMEDICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:LULTSCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-835-8935
Mailing Address - Street 1:3939 W RIDGE RD
Mailing Address - Street 2:SUITE A200
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-1879
Mailing Address - Country:US
Mailing Address - Phone:814-835-8935
Mailing Address - Fax:814-835-8408
Practice Address - Street 1:3939 W RIDGE RD
Practice Address - Street 2:SUITE A200
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1879
Practice Address - Country:US
Practice Address - Phone:814-835-8935
Practice Address - Fax:814-835-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050655L2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA199632OtherMEDICARE IND. NO.
PA30180152OtherAMERIHEALTH CARITAS
PA416488OtherUPMC HEALTH
PA3077237OtherHIGHMARK BLUE SHIELD
PA102546321 0002Medicaid