Provider Demographics
NPI:1720647951
Name:CONCIERGE ORTHOPEDIC SOLUTIONS LLC
Entity Type:Organization
Organization Name:CONCIERGE ORTHOPEDIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-461-6356
Mailing Address - Street 1:2531 CLEVELAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-4900
Mailing Address - Country:US
Mailing Address - Phone:239-461-6356
Mailing Address - Fax:239-461-6377
Practice Address - Street 1:2531 CLEVELAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-4900
Practice Address - Country:US
Practice Address - Phone:239-461-6356
Practice Address - Fax:239-461-6377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management