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NPI Code Detail

MEDICARE: CONCORD MEDICAL GROUP PLLC

MEDICARE: CONCORD MEDICAL GROUP PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083630610
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONCORD MEDICAL GROUP PLLC
Provider Business Mailing Address
First Line : PO BOX 3689
Second Line : DEPARTMENT 257
City : SUGAR LAND
State : TX
Zip : 77487-3310
Country : US
Telephone Number : 888-264-0330
Fax Number : 800-611-5029
Provider Business Practice Location Address
First Line : 1602 AVENUE Q
Second Line :
City : LUBBOCK
State : TX
Zip : 79401-4732
Country : US
Telephone Number : 888-264-0330
Fax Number : 800-611-5029
Authorized Official
Title or Position : EVP OF OPERATIONS
Name : MRS. JORDAN ANN TUCKETT
Credential :
Telephone Number : 972-829-6610
Provider Enumeration Date : 07/15/2006
Last Update Date : 01/08/2025

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