Basic Information
| Provider Information | |||||||||
| NPI: | 1750790762 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONCORD MEDICAL GROUP OF TEXAS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 96466 | ||||||||
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| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731436466 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 S GENEVA ST | ||||||||
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| City: | BRECKENRIDGE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764244702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2545592241 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2014 | ||||||||
| LastUpdateDate: | 08/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | SHEETS | ||||||||
| AuthorizedOfficialFirstName: | HARRY | ||||||||
| AuthorizedOfficialMiddleName: | K. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5756444427 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.