Healthcare Provider Details

I. General information

NPI: 1053135657
Provider Name (Legal Business Name): CONCIERGE WOUND CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 HICKAM AVE
LAS VEGAS NV
89129-3625
US

IV. Provider business mailing address

8820 HICKAM AVE
LAS VEGAS NV
89129-3625
US

V. Phone/Fax

Practice location:
  • Phone: 702-438-2229
  • Fax:
Mailing address:
  • Phone: 702-438-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HERNANDEZ
Title or Position: BILLING MANAGER
Credential:
Phone: 980-989-9487