Provider Demographics
NPI:1295590453
Name:CORE MED PLLC
Entity type:Organization
Organization Name:CORE MED PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HASENCLEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-876-8628
Mailing Address - Street 1:902B S WALTON BLVD STE 18
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5770
Mailing Address - Country:US
Mailing Address - Phone:479-876-8628
Mailing Address - Fax:479-876-8643
Practice Address - Street 1:902B S WALTON BLVD STE 18
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5770
Practice Address - Country:US
Practice Address - Phone:479-876-8628
Practice Address - Fax:479-876-8643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty