Provider Demographics
NPI:1023287158
Name:CONCORD CLINIC
Entity type:Organization
Organization Name:CONCORD CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROYA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-963-3346
Mailing Address - Street 1:8000 ANDERSON SQ STE 113
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8482
Mailing Address - Country:US
Mailing Address - Phone:512-338-0171
Mailing Address - Fax:512-338-0771
Practice Address - Street 1:8000 ANDERSON SQ STE 113
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8482
Practice Address - Country:US
Practice Address - Phone:512-963-3372
Practice Address - Fax:512-233-0721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center