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General NPI Number Information
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NPI Number | 1487244133
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Entity Type | Organization
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Legal Business Name | OCCUMEDIX LLC
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 227 W 4TH ST
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City | CHARLOTTE
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State | NC
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Zip | 28202-1545
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Country | US
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Telephone | 980-223-5849
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 18264
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City | CHARLOTTE
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State | NC
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Zip | 28218-0264
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TYLER CLAYTON JENKINS
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Credential |
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Telephone | 704-530-4445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number |
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License Number State |
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