Provider Demographics
NPI:1255340758
Name:OCCUPATIONAL MEDICINE, INC.
Entity type:Organization
Organization Name:OCCUPATIONAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:304-522-7268
Mailing Address - Street 1:PO BOX 1180
Mailing Address - Street 2:
Mailing Address - City:LAVALETTE
Mailing Address - State:WV
Mailing Address - Zip Code:25535-1180
Mailing Address - Country:US
Mailing Address - Phone:304-522-7268
Mailing Address - Fax:304-525-5539
Practice Address - Street 1:4552 ROUTE 152
Practice Address - Street 2:
Practice Address - City:LAVALETTE
Practice Address - State:WV
Practice Address - Zip Code:25535-1180
Practice Address - Country:US
Practice Address - Phone:304-522-7268
Practice Address - Fax:304-525-5539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18116302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1558328179OtherINDIVIDUAL NPI #
WV1558328179OtherINDIVIDUAL NPI #