OrganizationConcourse Village Primary Care PllcSpecialistOther Service ProvidersPractice Address769 Concourse Vlg W, Bronx, NY 10451-3801(718) 402-4021PECOS EnrollmentBased on the most recent information from CMS, provider Concourse Village Primary Care Pllc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 8:41 AM.Profile DetailsProvider ID1093984981Provider TypeOrganizationFull NameConcourse Village Primary Care PllcSubpartNoEnumeration Date2/25/2008Last Updated2/25/2008Contact InformationPractice LocationPractice Address769 Concourse Vlg W, Bronx, NY 10451-3801Phone(718) 402-4021Fax(718) 402-4023Mailing LocationMailing Address769 Concourse Vlg W, Bronx, NY 10451-3801Phone(718) 402-4021Fax(718) 402-4023Authorized OfficialNameMacenat, Jean R. (President)Phone(718) 402-4021Provider TaxonomiesCodeDescriptionLicenseCode174400000XPrimaryDescriptionSpecialistOther Service ProvidersLicense211364New YorkProvider IdentifiersIDDescriptionIssuerIDJM0301AR0DescriptionOtherIssuerBLUE CROSS/SHIELD