Provider Demographics
NPI:1073072815
Name:CONCIERGE CLINIC LLC
Entity Type:Organization
Organization Name:CONCIERGE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLAWITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-236-0835
Mailing Address - Street 1:1301 W INDIAN HILLS DR UNIT 46
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-1939
Mailing Address - Country:US
Mailing Address - Phone:435-669-6603
Mailing Address - Fax:
Practice Address - Street 1:1224 S RIVER RD STE B101
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8365
Practice Address - Country:US
Practice Address - Phone:435-236-0835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty