Provider Demographics
NPI:1932559606
Name:COREVISION NETWORK, LLC
Entity Type:Organization
Organization Name:COREVISION NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDAGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:404-809-7764
Mailing Address - Street 1:411 S CASCADE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3809
Mailing Address - Country:US
Mailing Address - Phone:404-809-7764
Mailing Address - Fax:
Practice Address - Street 1:411 S CASCADE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3809
Practice Address - Country:US
Practice Address - Phone:404-809-7764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1778-00261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center