Healthcare Provider Details

I. General information

NPI: 1598998379
Provider Name (Legal Business Name): CONCHA AUDIOLOGY & REHABILITATION, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S HARRISON ST STE 102
MT PLEASANT IA
52641-2300
US

IV. Provider business mailing address

207 S HARRISON ST STE 102
MT PLEASANT IA
52641-2300
US

V. Phone/Fax

Practice location:
  • Phone: 319-545-7125
  • Fax: 319-545-7127
Mailing address:
  • Phone: 319-545-7125
  • Fax: 319-545-7127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number482
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number759
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number747
License Number StateIA

VIII. Authorized Official

Name: DELFINO M CONCHA
Title or Position: PRESIDENT
Credential:
Phone: 319-545-7125