Occmed Source, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

OCCMED SOURCE, LLC

Practice address

174 Currie Hall Pkwy
Suite D
Kent, OH 44240-4387

Phone

(330) 548-0086

Fax

(330) 548-0085

NPI assigned

Jun 10, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gregory A Moten, D.O.

Title

Medical Director

Phone

(330) 548-0086

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213056000000",
    "number": "1003076431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "174 CURRIE HALL PKWY",
            "address_2": "SUITE D",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442404387",
            "telephone_number": "330-548-0086",
            "fax_number": "330-548-0085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 CURRIE HALL PKWY",
            "address_2": "SUITE D",
            "city": "KENT",
            "state": "OH",
            "postal_code": "442404387",
            "telephone_number": "330-548-0086",
            "fax_number": "330-548-0085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCCMED SOURCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-10",
        "last_updated": "2008-06-10",
        "status": "A",
        "authorized_official_last_name": "MOTEN",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "330-548-0086",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.