Healthcare Provider Details

I. General information

NPI: 1245340389
Provider Name (Legal Business Name): OCCUNET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 BROADWAY ST
PADUCAH KY
42001-3124
US

IV. Provider business mailing address

2535 BROADWAY ST
PADUCAH KY
42001-3124
US

V. Phone/Fax

Practice location:
  • Phone: 270-575-3001
  • Fax: 270-575-0418
Mailing address:
  • Phone: 270-575-3001
  • Fax: 270-575-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number18801
License Number StateKY

VIII. Authorized Official

Name: DR. RON BARLOW
Title or Position: M.D.
Credential: M.D.
Phone: 270-575-3001