Basic Information
| Provider Information | |||||||||
| NPI: | 1033484282 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCCUPATIONAL HEALTH PROFESSIONALS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 51328 | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421025628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707816477 | ||||||||
| FaxNumber: | 2707816479 | ||||||||
| Practice Location | |||||||||
| Address1: | 5796 NASHVILLE TD, STE A | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707816477 | ||||||||
| FaxNumber: | 2707816479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2012 | ||||||||
| LastUpdateDate: | 03/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | FORTNEY | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2707816477 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X | Y | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
No ID Information.