Provider Demographics
NPI:1740418292
Name:CORE MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:CORE MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DIXON
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:TUTOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-547-7596
Mailing Address - Street 1:2096 WHITE MCEWEN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28433-8570
Mailing Address - Country:US
Mailing Address - Phone:910-547-7596
Mailing Address - Fax:
Practice Address - Street 1:2096 WHITE MCEWEN RD
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:NC
Practice Address - Zip Code:28433-8570
Practice Address - Country:US
Practice Address - Phone:910-547-7596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies