Provider Demographics
NPI:1083630610
Name:CONCORD MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:CONCORD MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:SHEETS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-264-0330
Mailing Address - Street 1:PO BOX 3689
Mailing Address - Street 2:DEPARTMENT 257
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-3310
Mailing Address - Country:US
Mailing Address - Phone:888-264-0330
Mailing Address - Fax:800-611-5029
Practice Address - Street 1:1602 AVENUE Q
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-4732
Practice Address - Country:US
Practice Address - Phone:888-264-0330
Practice Address - Fax:800-611-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200065501Medicaid
TX290400Medicare PIN
TX00111ZMedicare PIN