Provider Demographics
NPI:1184080731
Name:COR MEDICAL LLC
Entity type:Organization
Organization Name:COR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:SA-C
Authorized Official - Phone:314-392-3998
Mailing Address - Street 1:5828 MANGO DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-2243
Mailing Address - Country:US
Mailing Address - Phone:314-701-4664
Mailing Address - Fax:
Practice Address - Street 1:5828 MANGO DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-2243
Practice Address - Country:US
Practice Address - Phone:314-701-4664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies