Healthcare Provider Details

I. General information

NPI: 1104263631
Provider Name (Legal Business Name): OCCUPATIONAL & ENVIRONMENTAL MEDICINE CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 10TH AVE SUITE 313
HUNTINGTON WV
25701-3581
US

IV. Provider business mailing address

1448 10TH AVE SUITE 313
HUNTINGTON WV
25701-3581
US

V. Phone/Fax

Practice location:
  • Phone: 304-523-8263
  • Fax:
Mailing address:
  • Phone: 304-523-8263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number9A021
License Number StateWV

VIII. Authorized Official

Name: SYAM B STOLL
Title or Position: CEO
Credential: MD
Phone: 304-523-8263