Provider Demographics
NPI:1801953468
Name:JCORE MEDICAL DIAGNOSTICS, INC.
Entity type:Organization
Organization Name:JCORE MEDICAL DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:COREY
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RVT, RNCST
Authorized Official - Phone:214-732-8165
Mailing Address - Street 1:PO BOX 2072
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0036
Mailing Address - Country:US
Mailing Address - Phone:214-732-8165
Mailing Address - Fax:866-261-1293
Practice Address - Street 1:7552 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-3448
Practice Address - Country:US
Practice Address - Phone:214-732-8165
Practice Address - Fax:866-261-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX627246ZE0600X
TX951672471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201119901Medicaid
TX201119901Medicaid