MEDICARE: OCCUMED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1851550370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUMED

Provider Business Mailing Address
First Line	:	2046 FOREST LN
Second Line	:	SUITE 180
City	:	GARLAND
State	:	TX
Zip	:	75042-7958
Country	:	US
Telephone Number	:	972-494-1419
Fax Number	:	972-494-2069

Provider Business Practice Location Address
First Line	:	2046 FOREST LN
Second Line	:	SUITE 180
City	:	GARLAND
State	:	TX
Zip	:	75042-7958
Country	:	US
Telephone Number	:	972-494-1419
Fax Number	:	972-494-2069

Authorized Official
Title or Position	:	MANAGER
Name	:	MATT MIDDLEBROOK
Credential	:
Telephone Number	:	972-494-1419

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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Directions to “OCCUMED ” Practice Location

Language	Start Address	Practice Location

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