MEDICARE: OCCUPATIONAL HEALTH CENTERS OF OHIO, P.A., CO.

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	:	1801032487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUPATIONAL HEALTH CENTERS OF OHIO, P.A., CO.

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DR
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	:	6133 ROCKSIDE RD
Second Line	:	SUITE 202
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2223
Country	:	US
Telephone Number	:	216-447-8350
Fax Number	:	216-447-1889

Authorized Official
Title or Position	:	SENIOR VP / CHIEF MEDICAL OFFICER
Name	:	DR. TOM FOGARTY
Credential	:	MD
Telephone Number	:	972-364-8103

Provider Enumeration Date	:	01/02/2009
Last Update Date	:	01/02/2009

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