MEDICARE: OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QP2000X	Physical Therapy Clinic/Center
2	261QX0100X	Occupational Medicine Clinic/Center
3	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1649434168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST, P.A.

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DR
Second Line	:	1200 WEST TOWER
City	:	ADDISON
State	:	TX
Zip	:	75001-4648
Country	:	US
Telephone Number	:	800-232-3550
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 SAINT JOHN ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04102-3018
Country	:	US
Telephone Number	:	207-541-2869
Fax Number	:	207-317-8269

Authorized Official
Title or Position	:	EVP, CMO
Name	:	DR. TOM FOGARTY
Credential	:	MD
Telephone Number	:	800-232-3550

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	07/14/2008

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Directions to “OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST, P.A. ” Practice Location

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