Provider Demographics
NPI:1477840882
Name:CORK MEDICAL LLC
Entity Type:Organization
Organization Name:CORK MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-849-2675
Mailing Address - Street 1:600 NORTH INDUSTRIAL DRIVE
Mailing Address - Street 2:303
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563
Mailing Address - Country:US
Mailing Address - Phone:630-305-7125
Mailing Address - Fax:866-904-2946
Practice Address - Street 1:600 NORTH INDUSTRIAL DRIVE
Practice Address - Street 2:303
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-305-7125
Practice Address - Fax:866-904-2946
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORK MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-06
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0332572-5332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies