1093957771 NPI number — OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093957771 NPI number — OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CONCENTRA MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093957771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5080 SPECTRUM DR
Provider Second Line Business Mailing Address:
SUITE 1200 WEST TOWER
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-4648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-720-7768
Provider Business Mailing Address Fax Number:
214-775-4502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14155 N 83RD AVE
Provider Second Line Business Practice Location Address:
BUILDING 8, SUITE 148
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85381-5639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-487-8598
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VP / CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
972-364-8000

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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