Provider Demographics
NPI:1821202870
Name:CONCHITALOPEZ
Entity Type:Organization
Organization Name:CONCHITALOPEZ
Other - Org Name:CONCHITALOPEZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:I.P.
Authorized Official - Prefix:MS
Authorized Official - First Name:CONCHITA
Authorized Official - Middle Name:ELEENA
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-235-3581
Mailing Address - Street 1:3122 SCOTTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-3446
Mailing Address - Country:US
Mailing Address - Phone:614-235-3581
Mailing Address - Fax:
Practice Address - Street 1:3122 SCOTTWOOD RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-3446
Practice Address - Country:US
Practice Address - Phone:614-235-3581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2078960Medicaid