Provider Demographics
NPI:1538429576
Name:CONCENTRA PRIMARY CARE OF ARIZONA PA
Entity type:Organization
Organization Name:CONCENTRA PRIMARY CARE OF ARIZONA PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TOM
Authorized Official - Last Name:FOGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-364-8000
Mailing Address - Street 1:5080 SPECTRUM DR
Mailing Address - Street 2:SUITE 1200 WEST
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:595 N DOBSON RD
Practice Address - Street 2:SUITE D-65
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4226
Practice Address - Country:US
Practice Address - Phone:480-545-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care