MEDICARE: OCCUPATIONAL MEDICINE, INC.

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	302F00000X	Exclusive Provider Organization	18116	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1558328179	OTHER	WV	INDIVIDUAL NPI #

General Provider Information

NPI Number	:	1255340758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUPATIONAL MEDICINE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1180
Second Line	:
City	:	LAVALETTE
State	:	WV
Zip	:	25535-1180
Country	:	US
Telephone Number	:	304-522-7268
Fax Number	:	304-525-5539

Provider Business Practice Location Address
First Line	:	4552 ROUTE 152
Second Line	:
City	:	LAVALETTE
State	:	WV
Zip	:	25535-1180
Country	:	US
Telephone Number	:	304-522-7268
Fax Number	:	304-525-5539

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PAUL W. CRAIG II
Credential	:	M.D.
Telephone Number	:	304-522-7268

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	08/22/2020

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Directions to “OCCUPATIONAL MEDICINE, INC. ” Practice Location

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