Provider Demographics
NPI:1568746345
Name:CONCERTO MEDICAL GROUP OF WASHINGTON, P.C.
Entity Type:Organization
Organization Name:CONCERTO MEDICAL GROUP OF WASHINGTON, P.C.
Other - Org Name:FIDELIS SENIOR CARE, INC.; FIDELIS SECURE HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP REVENUE CYCLE
Authorized Official - Prefix:MS
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:CHARLENE
Authorized Official - Last Name:DAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-553-3591
Mailing Address - Street 1:PO BOX 801280
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1280
Mailing Address - Country:US
Mailing Address - Phone:425-272-4600
Mailing Address - Fax:
Practice Address - Street 1:1412 SW 43RD STREET
Practice Address - Street 2:STE 315
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:425-272-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care