Healthcare Provider Details

I. General information

NPI: 1427484146
Provider Name (Legal Business Name): OCCUPATIONAL HEALTH CENTERS OF LOUISIANA, A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 AIRLINE DR SUITE 100
BOSSIER CITY LA
71111-3105
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 318-519-3088
  • Fax: 214-775-4502
Mailing address:
  • Phone: 972-364-8000
  • Fax: 214-775-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty 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. ROBERT G. HASSETT
Title or Position: SENIOR VP/CHIEF OFFICER
Credential: DO, MPH
Phone: 972-364-8000