Provider Demographics
NPI:1851425904
Name:CORNER MEDICAL LLC
Entity Type:Organization
Organization Name:CORNER MEDICAL LLC
Other - Org Name:CORNER HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-535-5335
Mailing Address - Street 1:14690 GALAXIE AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-8522
Mailing Address - Country:US
Mailing Address - Phone:952-953-9945
Mailing Address - Fax:952-953-9957
Practice Address - Street 1:14690 GALAXIE AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-8522
Practice Address - Country:US
Practice Address - Phone:952-953-9945
Practice Address - Fax:952-953-9957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6217702332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN472415100Medicaid
4732520002Medicare NSC