Healthcare Provider Details

I. General information

NPI: 1639289937
Provider Name (Legal Business Name): OCCUMED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 STONECREST DR
HUNTINGTON WV
25701-9391
US

IV. Provider business mailing address

2 STONECREST DR
HUNTINGTON WV
25701-9391
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-2273
  • Fax: 304-525-2165
Mailing address:
  • Phone: 304-525-2273
  • Fax: 304-525-2165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number005812
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number2017-9518
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number005812
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number2017-9518
License Number StateWV

VIII. Authorized Official

Name: MR. TIMOTHY MARTIN
Title or Position: VP & COO
Credential:
Phone: 304-526-2052