Provider Demographics
NPI:1891776316
Name:CORTINO MOBILITY PLUS, LLC
Entity Type:Organization
Organization Name:CORTINO MOBILITY PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CORPUS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:763-521-0101
Mailing Address - Street 1:PO BOX 22038
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-0038
Mailing Address - Country:US
Mailing Address - Phone:763-521-0101
Mailing Address - Fax:
Practice Address - Street 1:3758 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2336
Practice Address - Country:US
Practice Address - Phone:763-521-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8057694332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5601980001Medicare NSC