Provider Demographics
NPI: | 1609136845 |
---|---|
Name: | OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST PA |
Entity Type: | Organization |
Organization Name: | OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST PA |
Other - Org Name: | CONCENTRA MEDICAL CENTERS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
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 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: | 201 S RALEIGH RD |
Practice Address - Street 2: | |
Practice Address - City: | ENID |
Practice Address - State: | OK |
Practice Address - Zip Code: | 73701-7800 |
Practice Address - Country: | US |
Practice Address - Phone: | 580-616-6829 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-05-22 |
Last Update Date: | 2012-06-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service |