Provider Demographics
NPI:1881919777
Name:CONCENTRA WORKSITE OF ARIZONA, PA
Entity type:Organization
Organization Name:CONCENTRA WORKSITE OF ARIZONA, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP / CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-364-8000
Mailing Address - Street 1:4645 E COTTON CENTER BLVD
Mailing Address - Street 2:BLDG 1 - F829
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-8874
Mailing Address - Country:US
Mailing Address - Phone:602-586-1854
Mailing Address - Fax:602-431-7078
Practice Address - Street 1:5080 SPECTRUM DR
Practice Address - Street 2:SUITE 1200W
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4648
Practice Address - Country:US
Practice Address - Phone:972-364-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care