Provider Demographics
NPI:1609221019
Name:OCCUSPECIALIST, P.C.
Entity Type:Organization
Organization Name:OCCUSPECIALIST, P.C.
Other - Org Name:ADVANCED MEDICAL SPECIALIST
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAAD
Authorized Official - Middle Name:
Authorized Official - Last Name:YALDO
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 W
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:214-775-4502
Practice Address - Street 1:555 VALLEY VIEW DR
Practice Address - Street 2:N/A
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6138
Practice Address - Country:US
Practice Address - Phone:312-666-0028
Practice Address - Fax:312-666-5214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service