Provider Demographics
NPI:1518278696
Name:ONSITE OCCMED PA
Entity Type:Organization
Organization Name:ONSITE OCCMED PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP, CMO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
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 1:86 S COBB DR
Practice Address - Street 2:MZ: 0446
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30063-0001
Practice Address - Country:US
Practice Address - Phone:770-494-7134
Practice Address - Fax:770-494-8248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care