1285965053 NPI number — CORNER MEDICAL LLC

Table of content: (NPI 1285965053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285965053 NPI number — CORNER MEDICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNER MEDICAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CORNER HOME MEDICAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285965053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 17TH AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55901-0327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-208-4350
Provider Business Mailing Address Fax Number:
507-208-4236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 17TH AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55901-0327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-208-4350
Provider Business Practice Location Address Fax Number:
507-208-4236
Provider Enumeration Date:
01/19/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STEINHAUSER
Authorized Official First Name:
DAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
763-535-5335

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  361419 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)