MEDICARE: OCCMED SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1093070187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCMED SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	3124 ROSS CLARK CIR
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36303-3038
Country	:	US
Telephone Number	:	334-678-9123
Fax Number	:

Provider Business Practice Location Address
First Line	:	3124 ROSS CLARK CIR
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36303-3038
Country	:	US
Telephone Number	:	334-678-9123
Fax Number	:

Authorized Official
Title or Position	:	CRNP
Name	:	MISS CINDY RUTH LEE
Credential	:	CRNP
Telephone Number	:	334-678-9123

Provider Enumeration Date	:	07/05/2012
Last Update Date	:	07/05/2012

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