Provider Demographics
NPI:1295923449
Name:AMERICORF,LLC
Entity type:Organization
Organization Name:AMERICORF,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REVELL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:RRT, MBA
Authorized Official - Phone:877-822-2256
Mailing Address - Street 1:2312 COMANCHE TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8595
Mailing Address - Country:US
Mailing Address - Phone:877-822-2256
Mailing Address - Fax:
Practice Address - Street 1:2312 COMANCHE TRL
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8595
Practice Address - Country:US
Practice Address - Phone:877-822-2256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50966332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies