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General NPI Number Information
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NPI Number | 1649434168
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Entity Type | Organization
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Legal Business Name | OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST, P.A.
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 54 SAINT JOHN ST
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City | PORTLAND
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State | ME
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Zip | 04102-3018
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Country | US
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Telephone | 207-541-2869
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Fax | 207-317-8269
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Provider Business Mailing Address
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Address Line | 5080 SPECTRUM DR 1200 WEST TOWER
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City | ADDISON
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State | TX
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Zip | 75001-4648
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Country | US
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Telephone | 800-232-3550
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Fax |
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Authorized Official
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Title or Position | EVP, CMO
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Name | DR. TOM FOGARTY
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Credential | MD
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Telephone | 800-232-3550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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