Provider Demographics
NPI:1184090763
Name:CONVENIENT CONCIERGE HEALTHCARE
Entity type:Organization
Organization Name:CONVENIENT CONCIERGE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANSANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-658-6483
Mailing Address - Street 1:922 JERICHO CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3422
Mailing Address - Country:US
Mailing Address - Phone:704-658-6483
Mailing Address - Fax:
Practice Address - Street 1:922 JERICHO CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-3422
Practice Address - Country:US
Practice Address - Phone:704-658-6483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONVENIENT CONCIERGE HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty