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General NPI Number Information
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NPI Number | 1003006818
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Entity Type | Organization
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Legal Business Name | EXCEL OCCUPATIONAL CLINICS
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 07/27/2007
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Provider Practice Location Address
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Address Line | 6450 BRENTWOOD STAIR RD SUITE 110
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City | FORT WORTH
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State | TX
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Zip | 76112-3239
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Country | US
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Telephone | 817-654-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 6450 BRENTWOOD STAIR RD SUITE 110
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City | FORT WORTH
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State | TX
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Zip | 76112-3239
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Country | US
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Telephone | 817-654-0500
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOHN R BENNETT
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Credential | M.D
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Telephone | 817-654-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | D1546
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License Number State | TX
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