=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003321563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST, P.A. (UT)
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2017
-----------------------------------------------------
Last Update Date | 06/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2086 N 1700 W STE A
-----------------------------------------------------
City | LAYTON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84041-1166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-773-3400
-----------------------------------------------------
Fax | 801-773-3401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5080 SPECTRUM DRIVE SUITE 1200 WEST
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75001-4648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-364-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | DR. JOHN R ANDERSON
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 972-364-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QX0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------