Healthcare Provider Details

I. General information

NPI: 1356779862
Provider Name (Legal Business Name): OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2013
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E JEFFERSON ST
PHOENIX AZ
85034-2219
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 602-256-2281
  • Fax: 214-775-4502
Mailing address:
  • Phone: 972-720-7768
  • Fax: 214-775-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN ANDERSON
Title or Position: PRESIDENT
Credential: DO
Phone: 972-364-8000