Provider Demographics
NPI:1083759757
Name:COREY MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:COREY MEDICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REINALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:IBARGUENGOITIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-822-7989
Mailing Address - Street 1:5080 E 4TH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1545
Mailing Address - Country:US
Mailing Address - Phone:305-822-7989
Mailing Address - Fax:305-822-5173
Practice Address - Street 1:5080 E 4TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1545
Practice Address - Country:US
Practice Address - Phone:305-822-7989
Practice Address - Fax:305-822-5173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL802332B00000X, 332BP3500X
FL321878332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL951299300Medicaid
FL6880258 00Medicaid
FLR8829OtherBLUE CROSS BLUE SHIELD
FL802OtherHOME MEDICAL EQUIPMENT
FLR8829OtherBLUE CROSS BLUE SHIELD