Provider Demographics
NPI:1932213410
Name:JCORE MEDICAL DIAGNOSITCS
Entity Type:Organization
Organization Name:JCORE MEDICAL DIAGNOSITCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:C
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-732-8165
Mailing Address - Street 1:2529 GLENOAKS CT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4722
Mailing Address - Country:US
Mailing Address - Phone:214-732-8165
Mailing Address - Fax:817-488-0945
Practice Address - Street 1:2529 GLENOAKS CT
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4722
Practice Address - Country:US
Practice Address - Phone:214-732-8165
Practice Address - Fax:817-488-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXY35789Medicare UPIN
TXFTV011Medicare ID - Type Unspecified