Provider Demographics
NPI:1245048255
Name:CORE MEDICAL & AESTHETICS, LLC
Entity type:Organization
Organization Name:CORE MEDICAL & AESTHETICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:VERNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-207-2441
Mailing Address - Street 1:1301 E SUNSHINE ST STE 118
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1152
Mailing Address - Country:US
Mailing Address - Phone:417-207-2441
Mailing Address - Fax:
Practice Address - Street 1:1301 E SUNSHINE ST STE 118
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1152
Practice Address - Country:US
Practice Address - Phone:417-207-2441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty