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	:	1528210069
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	:	2151 EAST JEFFERSON AVENUE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-4161
Country	:	US
Telephone Number	:	313-259-7990
Fax Number	:	313-259-7294

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

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

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