Provider Demographics
NPI:1003452301
Name:COMPASSIONATE CONCIERGE PHYSICIANS, LLC
Entity Type:Organization
Organization Name:COMPASSIONATE CONCIERGE PHYSICIANS, LLC
Other - Org Name:COMPASSIONATE CONCIERGE PHYSICIANS - WOUND GRAFTS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-859-9722
Mailing Address - Street 1:5390 SAINT VRAIN RD
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-9307
Mailing Address - Country:US
Mailing Address - Phone:720-986-0850
Mailing Address - Fax:
Practice Address - Street 1:5390 SAINT VRAIN RD
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-9307
Practice Address - Country:US
Practice Address - Phone:720-986-0850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPASSIONATE CONCIERGE PHYSICIANS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-21
Last Update Date:2023-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty