1386290302 NPI number — CONCERTOHEALTH OF OHIO 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 1386290302 NPI number — CONCERTOHEALTH OF OHIO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCERTOHEALTH OF OHIO 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:
1386290302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
811 MAIN STREET, 7TH FLOOR
Provider Second Line Business Mailing Address:
ATTN: LBX 801280
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-670-6418
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5553 SOUTHWYCK BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-597-1440
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BRYANT
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
949-689-9526

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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