Provider Demographics
NPI:1407167729
Name:CONCENTRA WORKSITE OF CALIFORNIA, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CONCENTRA WORKSITE OF CALIFORNIA, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP, CMO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TOM
Authorized Official - Last Name:FOGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-364-8000
Mailing Address - Street 1:5080 SPECTRUM DR
Mailing Address - Street 2:SUITE 1200W
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1011 LOCKHEED WAY
Practice Address - Street 2:BUILDING 601, MZ: 1045
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93599-0001
Practice Address - Country:US
Practice Address - Phone:661-572-4017
Practice Address - Fax:661-572-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care