Provider Demographics
NPI:1265804181
Name:COR MEDICAL LLC
Entity type:Organization
Organization Name:COR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:NAPOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-362-1500
Mailing Address - Street 1:100 CENTURYLINK DR
Mailing Address - Street 2:MAILSTOP LA00010100-153
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2041
Mailing Address - Country:US
Mailing Address - Phone:318-362-1500
Mailing Address - Fax:318-807-3912
Practice Address - Street 1:100 CENTURYLINK DR
Practice Address - Street 2:MAILSTOP LA00010100-153
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2041
Practice Address - Country:US
Practice Address - Phone:318-362-1500
Practice Address - Fax:318-361-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 15498R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1464279Medicaid
LA5CK88Medicare PIN
LAH11525Medicare UPIN