Provider Demographics
NPI:1275904823
Name:MIDWEST CONCIERGE OF NAPLES, LLC
Entity Type:Organization
Organization Name:MIDWEST CONCIERGE OF NAPLES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TROUP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-529-4100
Mailing Address - Street 1:13386 KENT ST
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3929
Mailing Address - Country:US
Mailing Address - Phone:239-529-4100
Mailing Address - Fax:954-510-2086
Practice Address - Street 1:501 GOODLETTE RD N STE A103
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5663
Practice Address - Country:US
Practice Address - Phone:239-529-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11799261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care