Provider Demographics
NPI:1053845818
Name:CONCORD SCHOOL-LINKED HEALTH CENTER
Entity Type:Organization
Organization Name:CONCORD SCHOOL-LINKED HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAGNESS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:517-750-7393
Mailing Address - Street 1:203 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MI
Mailing Address - Zip Code:49237-9655
Mailing Address - Country:US
Mailing Address - Phone:517-750-7393
Mailing Address - Fax:
Practice Address - Street 1:203 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MI
Practice Address - Zip Code:49237-9655
Practice Address - Country:US
Practice Address - Phone:517-750-7393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care