MEDICARE: CONCENTRA HEALTH SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1275782229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCENTRA HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DRIVE
Second Line	:	SUITE 1200 WEST TOWER
City	:	ADDISON
State	:	TX
Zip	:	75001-4648
Country	:	US
Telephone Number	:	800-232-3550
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 NORTH HIGHWAY 360
Second Line	:	SUITE 2201
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-1009
Country	:	US
Telephone Number	:	972-988-0441
Fax Number	:	972-641-0054

Authorized Official
Title or Position	:	PRESIDENT / CEO
Name	:	KEITH NEWTON
Credential	:
Telephone Number	:	972-364-8106

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	10/07/2008

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