Healthcare Provider Details

I. General information

NPI: 1306219837
Provider Name (Legal Business Name): WORKFORCE HEALTH SYSTEM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 REGENCY PARKWAY SUITE 105
MANSFIELD TX
76063
US

IV. Provider business mailing address

2771 E BROAD ST
MANSFIELD TX
76063-9156
US

V. Phone/Fax

Practice location:
  • Phone: 800-859-3119
  • Fax: 866-561-4066
Mailing address:
  • Phone: 800-859-3119
  • Fax: 866-561-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: ABRAHAM CHUKWU
Title or Position: PRESIDENT
Credential: MD
Phone: 800-859-3119