Provider Demographics
NPI:1942438262
Name:CONCEPT PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:CONCEPT PROFESSIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:HERMAN
Authorized Official - Last Name:COTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-437-6971
Mailing Address - Street 1:4609 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-7915
Mailing Address - Country:US
Mailing Address - Phone:479-434-6971
Mailing Address - Fax:479-434-6974
Practice Address - Street 1:4609 S 16TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7915
Practice Address - Country:US
Practice Address - Phone:479-434-6971
Practice Address - Fax:479-434-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR6655630001Medicare NSC