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CENTERCORE MEDICAL LLC NPI 1306161427


NPI Information

NPI: 1306161427
Provider Name: CENTERCORE MEDICAL LLC
Classification: Prosthetic/Orthotic Supplier - 335E00000X
Entity Type: Organization
Address:
720 S PARK AVE
HERRIN, IL
ZIP 62948
Phone: (618) 713-6286
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CENTERCORE MEDICAL LLC is a prosthetic orthotic supplier in Herrin, IL. The provider is an organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. CENTERCORE MEDICAL LLC NPI is 1306161427. The provider is registered as an organization entity type.

The provider's business location address is:

720 S PARK AVE
HERRIN, IL
ZIP 62948-816
Phone: (618) 713-6286
Fax: (618) 985-4636

The provider's authorized official is Corene Mavigliano .
The authorized official title is Owner and has the following contact phone number (618) 713-6286.

The enumeration date for this NPI number is 3/31/2010 and was last updated on 3/31/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1335E00000XProsthetic/Orthotic SupplierYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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