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General NPI Number Information
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NPI Number | 1407407380
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Entity Type | Organization
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Legal Business Name | COMMUNITYMED OCCMED PLLC
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Dates
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Enumeration Date | 09/23/2019
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Last Update Date | 09/23/2019
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Provider Practice Location Address
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Address Line | 3591 MCKINNEY ST STE 400
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City | MELISSA
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State | TX
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Zip | 75454-9504
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Country | US
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Telephone | 972-521-8117
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Fax |
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Provider Business Mailing Address
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Address Line | 16775 ADDISON RD STE 200
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City | ADDISON
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State | TX
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Zip | 75001-5654
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Country | US
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Telephone | 972-521-8117
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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. GREGORY BLOMQUIST
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Credential |
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Telephone | 972-521-8117
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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 |
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License Number State |
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