Provider Demographics
NPI:1952044885
Name:DAVID COREY MEDICAL, LLC.
Entity Type:Organization
Organization Name:DAVID COREY MEDICAL, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:COREY
Authorized Official - Last Name:STAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-261-1740
Mailing Address - Street 1:463688 STATE ROAD 200 STE 200
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-0304
Mailing Address - Country:US
Mailing Address - Phone:904-261-1740
Mailing Address - Fax:
Practice Address - Street 1:463688 STATE ROAD 200 STE 200
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-0304
Practice Address - Country:US
Practice Address - Phone:904-261-1740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment