MEDICARE: CONCENTRA HEALTH SEVICES, INC.

Medicare Provider Information

Scope of Practice

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

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

General Provider Information

NPI Number	:	1871758599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCENTRA HEALTH SEVICES, INC.

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	:	109 MINIS AVE
Second Line	:	SUITE C -10
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-2128
Country	:	US
Telephone Number	:	912-966-5445
Fax Number	:	912-966-5955

Authorized Official
Title or Position	:	EVP, CMO
Name	:	DR. TOM FOGARTY
Credential	:	MD
Telephone Number	:	800-232-3550

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	07/22/2008

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