MEDICARE: ONSITE OCCMED PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1932443140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONSITE OCCMED PA

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DR
Second Line	:	SUITE 1200 WEST
City	:	ADDISON
State	:	TX
Zip	:	75001-4648
Country	:	US
Telephone Number	:	972-364-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 GREENVILLE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-2912
Country	:	US
Telephone Number	:	214-821-6007
Fax Number	:	214-821-6149

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM TOM FOGARTY
Credential	:	M.D.
Telephone Number	:	972-364-8000

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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Directions to “ONSITE OCCMED PA ” Practice Location

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