Provider Demographics
NPI:1407407380
Name:COMMUNITYMED OCCMED PLLC
Entity Type:Organization
Organization Name:COMMUNITYMED OCCMED PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-521-8117
Mailing Address - Street 1:16775 ADDISON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5654
Mailing Address - Country:US
Mailing Address - Phone:972-521-8117
Mailing Address - Fax:
Practice Address - Street 1:3591 MCKINNEY ST STE 400
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-9504
Practice Address - Country:US
Practice Address - Phone:972-521-8117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine