MEDICARE: OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST PA

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	261QH0100X	Health Service Clinic/Center
3	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1972093680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUPATIONAL HEALTH CENTERS OF THE SOUTHWEST PA

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	:	100 HIGH RISE DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40213-3251
Country	:	US
Telephone Number	:	502-964-3688
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	ROBERT G HASSETT
Credential	:
Telephone Number	:	972-364-8000

Provider Enumeration Date	:	05/17/2018
Last Update Date	:	05/17/2018

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