Provider Demographics
NPI: | 1043566060 |
---|---|
Name: | OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST P.A. |
Entity Type: | Organization |
Organization Name: | OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST P.A. |
Other - Org Name: | CONCENTRA MEDICAL CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | G |
Authorized Official - Last Name: | HASSETT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 972-364-8000 |
Mailing Address - Street 1: | 5080 SPECTRUM DR |
Mailing Address - Street 2: | SUITE 1200 WEST |
Mailing Address - City: | ADDISON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75001-4648 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-364-8000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3174 CUSTER DR |
Practice Address - Street 2: | SUITE 100 |
Practice Address - City: | LEXINGTON |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40517-4000 |
Practice Address - Country: | US |
Practice Address - Phone: | 800-232-3550 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-07-27 |
Last Update Date: | 2023-12-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service |