Provider Demographics
NPI:1679830848
Name:CONCIERGE MEDICAL CONSULTANTS, LLC
Entity Type:Organization
Organization Name:CONCIERGE MEDICAL CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-490-9841
Mailing Address - Street 1:12 KATIE LN
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5549
Mailing Address - Country:US
Mailing Address - Phone:817-490-9841
Mailing Address - Fax:817-490-0920
Practice Address - Street 1:12 KATIE LN
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5549
Practice Address - Country:US
Practice Address - Phone:817-490-9841
Practice Address - Fax:817-490-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty