1679804561 NPI number — CONCISE MEDICAL SERVICES, LLC.

Table of content: (NPI 1679804561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679804561 NPI number — CONCISE MEDICAL SERVICES, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCISE MEDICAL SERVICES, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679804561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3545 CRUSE RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30044-3170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-502-7460
Provider Business Mailing Address Fax Number:
866-645-5987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3545 CRUSE RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30044-3170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-502-7460
Provider Business Practice Location Address Fax Number:
866-645-5987
Provider Enumeration Date:
01/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LLC
Authorized Official First Name:
CONCISE MEDICAL SERV
Authorized Official Middle Name:
SERVICES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
678-502-7460

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  20100117 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20100117 . This is a "DMEHS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com