Basic Information
| Provider Information | |||||||||
| NPI: | 1639311301 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONCENTRA HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5080 SPECTRUM DR | ||||||||
| Address2: | SUITE 1200 WEST TOWER | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750014648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002323550 | ||||||||
| FaxNumber: | 2147754515 | ||||||||
| Practice Location | |||||||||
| Address1: | 14155 N 83RD AVE | ||||||||
| Address2: | BUILDING H, SUITE 101 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853815639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234878598 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2009 | ||||||||
| LastUpdateDate: | 04/02/2009 | ||||||||
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| AuthorizedOfficialLastName: | NEWTON | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT / CEO | ||||||||
| AuthorizedOfficialTelephone: | 8002323550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.