Healthcare Provider Details

I. General information

NPI: 1740445196
Provider Name (Legal Business Name): CONCENTRA HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 BEN HUR AVENUE
WILLOUGHBY OH
44094
US

IV. Provider business mailing address

5080 SPECTRUM DRIVE SUITE 1200 WEST
ADDISON TX
75001-4625
US

V. Phone/Fax

Practice location:
  • Phone: 440-975-4185
  • Fax: 440-975-4195
Mailing address:
  • Phone: 800-232-3550
  • Fax: 972-387-8058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KEITH NEWTON
Title or Position: PRESIDENT
Credential:
Phone: 800-232-3550