1326809559 NPI number — HOUSE CALL CONCIERGE MEDICINE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326809559 NPI number — HOUSE CALL CONCIERGE MEDICINE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUSE CALL CONCIERGE MEDICINE, 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:
1326809559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 PARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEBSTER GROVES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63119-2533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-452-3780
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
865 LONGBOAT CLUB RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGBOAT KEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34228-3803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-452-3780
Provider Business Practice Location Address Fax Number:
731-201-5047
Provider Enumeration Date:
01/16/2024

Additional Information

Authorized Official

Authorized Official Last Name:
O'DONNELL
Authorized Official First Name:
KIRK
Authorized Official Middle Name:
NIELSEN
Authorized Official Title or Position:
CO-OWNER, CO-FOUNDER, AND CLINICIAN
Authorized Official Telephone Number:
314-452-3780

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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