Healthcare Provider Details

I. General information

NPI: 1093594558
Provider Name (Legal Business Name): CONCIERGE ANCILLARY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 HIGHWAY 332 W STE J133
LAKE JACKSON TX
77566-4023
US

IV. Provider business mailing address

117 HIGHWAY 332 W STE J133
LAKE JACKSON TX
77566-4023
US

V. Phone/Fax

Practice location:
  • Phone: 713-688-3188
  • Fax: 346-226-7036
Mailing address:
  • Phone: 713-688-3188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TE-JUAN ANDERSON
Title or Position: CEO
Credential:
Phone: 713-688-3188