Provider Demographics
NPI:1003694845
Name:CORNER MEDICAL LLC
Entity Type:Organization
Organization Name:CORNER MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BAGSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-540-6119
Mailing Address - Street 1:2730 NEVADA AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2807
Mailing Address - Country:US
Mailing Address - Phone:763-535-5335
Mailing Address - Fax:763-536-3590
Practice Address - Street 1:124 EMERSON ST N
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1300
Practice Address - Country:US
Practice Address - Phone:866-535-5335
Practice Address - Fax:763-536-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies