1861752099 NPI number — OCCUPATIONAL HEALTH CENTERS OF NORTH CAROLINA PC

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 1861752099 NPI number — OCCUPATIONAL HEALTH CENTERS OF NORTH CAROLINA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCCUPATIONAL HEALTH CENTERS OF NORTH CAROLINA PC
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:
Provider Other Organization Name Type Code:
6
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:
1861752099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2012
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
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:
972-364-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3437 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAREMONT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28610-8672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-850-4444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2012

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: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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