# CONCORD PREMIUM GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255665162
- **Authorized official:** DANIEL W THOMPSON (CEO)
- **Authorized official phone:** (801) 300-5159

## Contact information

- **Practice address:** 356 N 750 W, STE D9-213, AMERICAN FORK, UT 84003-1678
- **Practice address phone:** (801) 300-5159
- **Mailing address:** 356 N 750 W, STE D9-213, AMERICAN FORK, UT 84003-1678

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 3713101205 | UT | Yes |

## Other

- **Enumeration date:** 09/24/2009
- **Last updated:** 10/16/2009