Provider Demographics
NPI:1265170658
Name:COREMEDX INC.
Entity type:Organization
Organization Name:COREMEDX INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:CALEB
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-797-4455
Mailing Address - Street 1:441 PINEY FOREST RD STE G
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4154
Mailing Address - Country:US
Mailing Address - Phone:434-793-0700
Mailing Address - Fax:434-793-9315
Practice Address - Street 1:1461 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-3120
Practice Address - Country:US
Practice Address - Phone:540-375-9220
Practice Address - Fax:434-793-9315
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COREMEDX
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-25
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty