Provider Demographics
NPI:1942692348
Name:MEDICOR HEALTHCARE, INC
Entity Type:Organization
Organization Name:MEDICOR HEALTHCARE, INC
Other - Org Name:MEDICOR HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:813-930-8000
Mailing Address - Street 1:5015 GA HIGHWAY 85
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-2431
Mailing Address - Country:US
Mailing Address - Phone:404-228-8470
Mailing Address - Fax:404-228-8575
Practice Address - Street 1:4820 HAMMERMILL RD STE G
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6606
Practice Address - Country:US
Practice Address - Phone:800-250-4468
Practice Address - Fax:866-930-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHDME000364OtherSTATE OF GEORGIA BOARD OF PHARMACY