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	:	1669405551
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 DRIVE
Second Line	:	SUITE 1200 WEST TOWER
City	:	ADDISON
State	:	TX
Zip	:	75001
Country	:	US
Telephone Number	:	800-232-3550
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 EVERMAN PARKWAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140
Country	:	US
Telephone Number	:	817-293-7311
Fax Number	:	817-551-1066

Authorized Official
Title or Position	:	SENIOR VP / CHIEF MEDICAL OFFICER
Name	:	DR. TOM FOGARTY
Credential	:	M.D.
Telephone Number	:	972-364-8103

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	05/27/2010

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