| Organization Name: | OCCU - SPORTS MED CORP |
| NPI Number: | 1457344657 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CASTOLINA SOLIS (BILLING MANAGER) |
| Mailing Address: | 2615 Harrison St Bellwood |
| State: | IL US |
| Postal Code: | 601042450 |
| Phone Number: | 7084930199 |
| Fax Number: | 7084939683 |
| NPI Enumeration Date: | 08/24/2005 |
| NPI Last Update Date: | 11/08/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 036078648 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |