1003180159 NPI number — CONCENTRA HEALTH SERVICES INC

Table of content: (NPI 1003180159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003180159 NPI number — CONCENTRA HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCENTRA HEALTH SERVICES INC
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 COMPLIANCE ADMINISTRATION
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:
1003180159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9008
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOMFIELD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80021-9008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8850 FM 2658 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TATUM
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75691-3401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-289-6757
Provider Business Practice Location Address Fax Number:
800-310-5984
Provider Enumeration Date:
03/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FOGARTY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
TOM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-364-8000

Provider Taxonomy Codes

  • Taxonomy code: 261QR0208X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com