Healthcare Provider Details

I. General information

NPI: 1144798208
Provider Name (Legal Business Name): CONCORD SURGICAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 N CENTRAL EXPY
DALLAS TX
75231-2297
US

IV. Provider business mailing address

PO BOX 9
ROCKWALL TX
75087-0009
US

V. Phone/Fax

Practice location:
  • Phone: 214-771-0117
  • Fax: 415-795-4434
Mailing address:
  • Phone: 817-581-6100
  • Fax: 415-795-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: LORI SUZZETTE AARON
Title or Position: OWNER
Credential:
Phone: 903-227-1088