Basic Information
| Provider Information | |||||||||
| NPI: | 1386656791 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OCCUPATIONAL HEALTH CENTER | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CONCENTRA MEDICAL CENTER- FLAGSTAFF | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 120 W FINE AVE | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860013016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287739695 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 120 W FINE AVE | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860013016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287739695 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BATES | ||||||||
| AuthorizedOfficialFirstName: | BELINDA | ||||||||
| AuthorizedOfficialMiddleName: | GAIL | ||||||||
| AuthorizedOfficialTitleorPosition: | CENTER ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9287739695 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | OTC2207 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.