| Organization Name: | PROACTIVE OCCUPATIONAL MEDICINE, INC. |
| NPI Number: | 1043625213 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY BROWN (CEO) |
| Mailing Address: | 800 Wheeling Ave Suite 1w Glen Dale |
| State: | WV US |
| Postal Code: | 260381660 |
| Phone Number: | 7409618275 |
| Fax Number: | |
| NPI Enumeration Date: | 06/26/2014 |
| NPI Last Update Date: | 06/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QX0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Occupational Medicine |
| Taxonomy Definition: | |