Provider Demographics
NPI:1497193346
Name:COBBLER'S CORNER LLC
Entity Type:Organization
Organization Name:COBBLER'S CORNER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-482-4005
Mailing Address - Street 1:1115 VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-8480
Mailing Address - Country:US
Mailing Address - Phone:330-482-4005
Mailing Address - Fax:330-482-3703
Practice Address - Street 1:1115 VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-8480
Practice Address - Country:US
Practice Address - Phone:330-482-4005
Practice Address - Fax:330-482-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50079927332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6905920001Medicare NSC