Healthcare Provider Details

I. General information

NPI: 1811215957
Provider Name (Legal Business Name): OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 E ROUTE 66 SUITE 100
FLAGSTAFF AZ
86001-4771
US

IV. Provider business mailing address

5080 SPECTRUM DR SUITE 1200W
ADDISON TX
75001-4648
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-9695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM T FOGARTY
Title or Position: SVP / CMO
Credential: MD
Phone: 972-364-8000