Concord Medical Clinic, Inc.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

001001312 Issued in NC

Legal business name

CONCORD MEDICAL CLINIC, INC.

Practice address

1000 Copperfield Blvd NE
Suite 124
Concord, NC 28025-2453

Phone

(704) 782-6868

Fax

(704) 782-7585

NPI assigned

Aug 30, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Claudia Diaz, PA-C

Title

President

Phone

(704) 782-6868

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314662400000",
    "number": "1578844908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 COPPERFIELD BLVD NE",
            "address_2": "SUITE 124",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252453",
            "telephone_number": "704-782-6868",
            "fax_number": "704-782-7585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 COPPERFIELD BLVD NE",
            "address_2": "SUITE 124",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252453",
            "telephone_number": "704-782-6868",
            "fax_number": "704-782-7585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCORD MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-30",
        "last_updated": "2011-08-30",
        "status": "A",
        "authorized_official_last_name": "DIAZ",
        "authorized_official_first_name": "CLAUDIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-782-6868",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "001001312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Concord Eye Care Center, O.D., P.a.
• Concord Family Chiropractic
• Concord Health and Rehabilitation SNF LLC
• Concord Health Care LP
• Concord House LLC
• Concord Medical Transportation Services
• Concord Operator LLC
• Concord Pharmacy and Surgical Supply
• Concord Place
• Concord Specialty Pharmacy

• Physician Assistant in Concord, NC
• Providers in Concord, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.