Basic Information
| Provider Information | |||||||||
| NPI: | 1154871127 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CONCENTRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7421 CASS AVE | ||||||||
| Address2: | |||||||||
| City: | DARIEN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605613607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302865300 | ||||||||
| FaxNumber: | 6309861096 | ||||||||
| Practice Location | |||||||||
| Address1: | 7421 SOUTH CASS AVENUE | ||||||||
| Address2: | |||||||||
| City: | DARIEN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605613607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302865300 | ||||||||
| FaxNumber: | 6309861096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2016 | ||||||||
| LastUpdateDate: | 10/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | SKWARLO | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CENTER OPERATIONS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6302865300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X | 036.111003 | IL | Y | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
No ID Information.