Healthcare Provider Details

I. General information

NPI: 1649743667
Provider Name (Legal Business Name): CONCORD COMPANY OF TENNESSEE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 WALLACE AVE
LEITCHFIELD KY
42754-2414
US

IV. Provider business mailing address

PO BOX 3689 DEPT 504
SUGAR LAND TX
77487-3310
US

V. Phone/Fax

Practice location:
  • Phone: 270-256-9400
  • Fax:
Mailing address:
  • Phone: 888-264-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HARRY KYLE SHEETS
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 888-264-0330