Provider Demographics
NPI:1043358617
Name:OCCUTRAN TREATMENT CENTER, PLC
Entity type:Organization
Organization Name:OCCUTRAN TREATMENT CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-660-4916
Mailing Address - Street 1:174 MURRAY GUARD DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3742
Mailing Address - Country:US
Mailing Address - Phone:731-660-4916
Mailing Address - Fax:731-660-6759
Practice Address - Street 1:174 MURRAY GUARD DR
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3742
Practice Address - Country:US
Practice Address - Phone:731-660-4916
Practice Address - Fax:731-660-6759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN395982083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty