Provider Demographics
NPI:1326809559
Name:HOUSE CALL CONCIERGE MEDICINE, LLC
Entity Type:Organization
Organization Name:HOUSE CALL CONCIERGE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, CO-FOUNDER, AND CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:NIELSEN
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-452-3780
Mailing Address - Street 1:320 PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2533
Mailing Address - Country:US
Mailing Address - Phone:314-452-3780
Mailing Address - Fax:
Practice Address - Street 1:865 LONGBOAT CLUB RD
Practice Address - Street 2:
Practice Address - City:LONGBOAT KEY
Practice Address - State:FL
Practice Address - Zip Code:34228-3803
Practice Address - Country:US
Practice Address - Phone:314-452-3780
Practice Address - Fax:731-201-5047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty