MEDICARE: OCCUPATIONAL HEALTH CENTERS OF MINNESOTA PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QH0100X	Health Service Clinic/Center
2	261QP2000X	Physical Therapy Clinic/Center
3	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1417438870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUPATIONAL HEALTH CENTERS OF MINNESOTA PC

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DR STE 1200W
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-4624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	570 ASBURY ST STE 101
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-1852
Country	:	US
Telephone Number	:	651-888-6540
Fax Number	:	651-888-6545

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN ANDERSON
Credential	:
Telephone Number	:	972-364-8000

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	08/23/2018

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