Provider Demographics
NPI:1104263631
Name:OCCUPATIONAL & ENVIRONMENTAL MEDICINE CONSULTANTS, INC.
Entity type:Organization
Organization Name:OCCUPATIONAL & ENVIRONMENTAL MEDICINE CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SYAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:STOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-523-8263
Mailing Address - Street 1:1448 10TH AVE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3581
Mailing Address - Country:US
Mailing Address - Phone:304-523-8263
Mailing Address - Fax:
Practice Address - Street 1:1448 10TH AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3581
Practice Address - Country:US
Practice Address - Phone:304-523-8263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV9A021261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9A021OtherSTATE LICENSE