Provider Demographics
NPI:1972906758
Name:CONCORD MEDICAL GROUP, PLLC
Entity type:Organization
Organization Name:CONCORD MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:SHEETS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-264-0330
Mailing Address - Street 1:PO BOX 2858
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-2858
Mailing Address - Country:US
Mailing Address - Phone:888-264-0330
Mailing Address - Fax:800-611-5029
Practice Address - Street 1:600 S PINE ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4942
Practice Address - Country:US
Practice Address - Phone:337-462-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty