Provider Demographics
NPI:1114171535
Name:MEDICAL IMPLANT SLOUTIONS, LLC
Entity Type:Organization
Organization Name:MEDICAL IMPLANT SLOUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:LUCIANO
Authorized Official - Last Name:KOREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-840-2388
Mailing Address - Street 1:12639 OLD TESSON RD
Mailing Address - Street 2:116
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:303-840-2388
Mailing Address - Fax:
Practice Address - Street 1:12639 OLD TESSON RD
Practice Address - Street 2:116
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2786
Practice Address - Country:US
Practice Address - Phone:303-840-2388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies