Provider Demographics
NPI:1154201424
Name:OLYMPIC CONCIERGE MED, INC.
Entity type:Organization
Organization Name:OLYMPIC CONCIERGE MED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKHOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:352-551-5225
Mailing Address - Street 1:2519 CORDOBA RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-3960
Mailing Address - Country:US
Mailing Address - Phone:813-670-8915
Mailing Address - Fax:813-768-0175
Practice Address - Street 1:25200 SAWYER FRANCIS LN
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-6947
Practice Address - Country:US
Practice Address - Phone:813-670-8915
Practice Address - Fax:813-768-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty