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General NPI Number Information
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NPI Number | 1275565566
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Entity Type | Organization
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Legal Business Name | CONCORD PRIMARY CARE SERVICES
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 303 W SUNSET RD SUITE 201
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City | SAN ANTONIO
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State | TX
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Zip | 78209-1749
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Country | US
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Telephone | 210-732-0130
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Fax | 210-732-0120
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Provider Business Mailing Address
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Address Line | 303 W SUNSET RD SUITE 201
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City | SAN ANTONIO
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State | TX
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Zip | 78209-1749
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Country | US
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Telephone | 210-732-0130
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Fax | 210-732-0120
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS IFEOMA JACQUELINE OKOLO
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Credential | RN
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Telephone | 210-732-0130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 007836
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License Number State | TX
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