Provider Demographics
NPI:1962628008
Name:CONCIERGEHEALTH, LLC
Entity Type:Organization
Organization Name:CONCIERGEHEALTH, LLC
Other - Org Name:99W URGENT CARE AND HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAT
Authorized Official - Middle Name:DUC
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:971-226-2613
Mailing Address - Street 1:15280 SW WABLER WAY
Mailing Address - Street 2:102
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007
Mailing Address - Country:US
Mailing Address - Phone:971-226-2613
Mailing Address - Fax:
Practice Address - Street 1:11820 SW KING JAMES PL
Practice Address - Street 2:SUITE 30
Practice Address - City:KING CITY
Practice Address - State:OR
Practice Address - Zip Code:97224-2480
Practice Address - Country:US
Practice Address - Phone:971-226-2613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25886261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORI22102Medicare UPIN