Provider Demographics
NPI:1154083574
Name:CONCERTOCARE MEDICAL GROUP OF ARIZONA, P.C.
Entity type:Organization
Organization Name:CONCERTOCARE MEDICAL GROUP OF ARIZONA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-969-4746
Mailing Address - Street 1:21750 HARDY OAK BLVD
Mailing Address - Street 2:SUITE 104, PMB 72961
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4946
Mailing Address - Country:US
Mailing Address - Phone:877-597-1440
Mailing Address - Fax:
Practice Address - Street 1:215 FENWAY ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1409
Practice Address - Country:US
Practice Address - Phone:877-597-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty