Provider Demographics
NPI:1639289937
Name:OCCUMED, LLC
Entity Type:Organization
Organization Name:OCCUMED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-526-2052
Mailing Address - Street 1:2 STONECREST DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-9391
Mailing Address - Country:US
Mailing Address - Phone:304-525-2273
Mailing Address - Fax:304-525-2165
Practice Address - Street 1:2 STONECREST DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-9391
Practice Address - Country:US
Practice Address - Phone:304-525-2273
Practice Address - Fax:304-525-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 363A00000X, 363L00000X
WV005812261QU0200X, 261QX0100X
WV2017-9518261QU0200X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100387040OtherKY MEDICAID PA
OH2643689Medicaid
KY7100350570OtherKY MEDICAID NP
WV1639289937Medicaid
KY7100053990OtherKY MEDICAID DO/MD
WV3810006253Medicaid