Healthcare Provider Details

I. General information

NPI: 1396873048
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: 03/02/2007
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CONGRESS ST.
PORTLAND ME
04102
US

IV. Provider business mailing address

5080 SPECTRUM DRIVE SUITE 1200 WEST TOWER
ADDISON TX
75001
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-7751
  • Fax: 207-828-5140
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

VIII. Authorized Official

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