Provider Demographics
NPI: | 1760199194 |
---|---|
Name: | CORE MEDICAL CENTER CC LLC |
Entity Type: | Organization |
Organization Name: | CORE MEDICAL CENTER CC LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ASTON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GOLDSWORTHY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | FNP-BC |
Authorized Official - Phone: | 816-674-2693 |
Mailing Address - Street 1: | 1131 W MAIN ST STE C |
Mailing Address - Street 2: | |
Mailing Address - City: | BLUE SPRINGS |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 64015-3611 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 816-281-5275 |
Mailing Address - Fax: | 816-229-7085 |
Practice Address - Street 1: | 1131 W MAIN ST STE C |
Practice Address - Street 2: | |
Practice Address - City: | BLUE SPRINGS |
Practice Address - State: | MO |
Practice Address - Zip Code: | 64015-3611 |
Practice Address - Country: | US |
Practice Address - Phone: | 816-281-5275 |
Practice Address - Fax: | 816-229-7085 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-11-04 |
Last Update Date: | 2023-09-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 111NX0100X | Chiropractic Providers | Chiropractor | Occupational Health | Group - Multi-Specialty |
No | 202C00000X | Allopathic & Osteopathic Physicians | Independent Medical Examiner | Group - Multi-Specialty | |
No | 2081P0301X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Brain Injury Medicine | Group - Multi-Specialty |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
No | 2083X0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | Group - Multi-Specialty |
No | 2084P0301X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Brain Injury Medicine | Group - Multi-Specialty |
No | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | Group - Multi-Specialty |
No | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 363LX0106X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Occupational Health | Group - Multi-Specialty |