MEDICARE: CONCIERGE TESTING SOLUTIONS, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CV2237	OTHER	MO	PRIMARY CLINIC STATE OF MISSOURI PROVIDER NUMBER

General Provider Information

NPI Number	:	1851968226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCIERGE TESTING SOLUTIONS, LLC.

Provider Business Mailing Address
First Line	:	4851 MEADOWBROOK PKWY UNIT 158
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66207-3473
Country	:	US
Telephone Number	:	816-645-3635
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 E MEYER BLVD STE 1240A
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-1206
Country	:	US
Telephone Number	:	816-645-3635
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. SHANE SCOTT
Credential	:
Telephone Number	:	314-220-8279

Provider Enumeration Date	:	06/05/2021
Last Update Date	:	06/05/2021

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