Provider Demographics
NPI:1669848958
Name:CORK MEDICAL LLC
Entity Type:Organization
Organization Name:CORK MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCE / COMPLIANCE DIR.
Authorized Official - Prefix:
Authorized Official - First Name:DESMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-361-4563
Mailing Address - Street 1:6406 CASTLEWAY CT STE 100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1949
Mailing Address - Country:US
Mailing Address - Phone:317-361-4563
Mailing Address - Fax:
Practice Address - Street 1:9804 PFLUMM RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-1208
Practice Address - Country:US
Practice Address - Phone:913-495-9702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies