=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639360860
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCCUPATIENT MEDICAL SERVICES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2007
-----------------------------------------------------
Last Update Date | 06/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5651 FRIST BOULEVARD SUITE 306
-----------------------------------------------------
City | HERMITAGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-316-0100
-----------------------------------------------------
Fax | 615-872-0088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5651 FRIST BOULEVARD SUITE 306
-----------------------------------------------------
City | HERMITAGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-316-0100
-----------------------------------------------------
Fax | 615-872-0088
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RENATA ELIZABETH BLUHM
-----------------------------------------------------
Credential | MD, PHD
-----------------------------------------------------
Telephone | 615-316-0100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083X0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Physician
-----------------------------------------------------
License Number | MD19042
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD19042
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------