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	:	1871757401
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	:	SUITE 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	:	5701 W KIEST BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75236-1047
Country	:	US
Telephone Number	:	214-775-2928
Fax Number	:	214-775-2953

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

Provider Enumeration Date	:	07/13/2008
Last Update Date	:	07/13/2008

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