Provider Demographics
NPI:1376863761
Name:COR DIAGNOSTIC SPECIALISTS LLC
Entity Type:Organization
Organization Name:COR DIAGNOSTIC SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SALES
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-331-6098
Mailing Address - Street 1:PO BOX 4932
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81658-4932
Mailing Address - Country:US
Mailing Address - Phone:970-331-6098
Mailing Address - Fax:970-300-1813
Practice Address - Street 1:3901 BIG HORN RD
Practice Address - Street 2:UNIT 2F
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-4716
Practice Address - Country:US
Practice Address - Phone:970-331-6098
Practice Address - Fax:970-300-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic