Provider Demographics
NPI:1548734627
Name:MEDICORE MEDICAL SERVICE LLC
Entity Type:Organization
Organization Name:MEDICORE MEDICAL SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZATOR/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:OLESYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-293-1457
Mailing Address - Street 1:2303 KRATKY RD APT B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-1783
Mailing Address - Country:US
Mailing Address - Phone:636-293-1457
Mailing Address - Fax:
Practice Address - Street 1:2303 KRATKY RD APT B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-1783
Practice Address - Country:US
Practice Address - Phone:636-293-1457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility