Healthcare Provider Details

I. General information

NPI: 1104088277
Provider Name (Legal Business Name): OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7764 NORMANDY BLVD STE. 24
JACKSONVILLE FL
32221-7652
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 904-482-1400
  • Fax: 904-482-1407
Mailing address:
  • Phone: 800-232-3500
  • 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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT G HASSETT
Title or Position: VP
Credential:
Phone: 972-364-8000