Provider Demographics
NPI:1386290302
Name:CONCERTOHEALTH OF OHIO LLC
Entity type:Organization
Organization Name:CONCERTOHEALTH OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-689-9526
Mailing Address - Street 1:811 MAIN STREET, 7TH FLOOR
Mailing Address - Street 2:ATTN: LBX 801280
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105
Mailing Address - Country:US
Mailing Address - Phone:949-670-6418
Mailing Address - Fax:
Practice Address - Street 1:5553 SOUTHWYCK BOULEVARD
Practice Address - Street 2:SUITE 101
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614
Practice Address - Country:US
Practice Address - Phone:877-597-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCERTO HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-15
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty