Healthcare Provider Details

I. General information

NPI: 1760491187
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: 08/05/2006
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 YORK ROAD SUITE E
TIMONIUM MD
21093
US

IV. Provider business mailing address

5080 SPECTRUM DRIVE SUITE 1200 WEST TOWER
ADDISON TX
75001
US

V. Phone/Fax

Practice location:
  • Phone: 410-252-4015
  • Fax: 410-252-7410
Mailing address:
  • Phone: 800-232-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. TOM FOGARTY
Title or Position: SENIOR VP / CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 972-364-8103