Provider Demographics
NPI:1518399799
Name:MEDICOR HEALTHCARE, INC.
Entity Type:Organization
Organization Name:MEDICOR HEALTHCARE, INC.
Other - Org Name:MEDICOR HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-556-2749
Mailing Address - Street 1:3436 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-2469
Mailing Address - Country:US
Mailing Address - Phone:504-556-2749
Mailing Address - Fax:504-556-2784
Practice Address - Street 1:3436 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-2469
Practice Address - Country:US
Practice Address - Phone:504-556-2749
Practice Address - Fax:504-556-2784
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICOR HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-30
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies