Provider Demographics
NPI:1093023285
Name:CORE CLINICS, LLC
Entity Type:Organization
Organization Name:CORE CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MAJOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:225-756-2676
Mailing Address - Street 1:10059 N REIGER RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-4559
Mailing Address - Country:US
Mailing Address - Phone:225-456-2330
Mailing Address - Fax:225-456-2301
Practice Address - Street 1:10059 N. REIGER ROAD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809
Practice Address - Country:US
Practice Address - Phone:225-456-2330
Practice Address - Fax:225-456-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty