Healthcare Provider Details

I. General information

NPI: 1942438262
Provider Name (Legal Business Name): CONCEPT PROFESSIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4609 S 16TH ST
FORT SMITH AR
72901-7915
US

IV. Provider business mailing address

4609 S 16TH ST
FORT SMITH AR
72901-7915
US

V. Phone/Fax

Practice location:
  • Phone: 479-434-6971
  • Fax: 479-434-6974
Mailing address:
  • Phone: 479-434-6971
  • Fax: 479-434-6974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DAN HERMAN COTTA
Title or Position: OWNER, CEO
Credential:
Phone: 479-437-6971