Healthcare Provider Details

I. General information

NPI: 1508495797
Provider Name (Legal Business Name): CORNER MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 CENTER AVE W
DILWORTH MN
56529-1352
US

IV. Provider business mailing address

2730 NEVADA AVE N
NEW HOPE MN
55427-2807
US

V. Phone/Fax

Practice location:
  • Phone: 218-359-2122
  • Fax: 218-359-2121
Mailing address:
  • Phone: 763-535-5335
  • Fax: 763-536-3590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT WILLIAM NEUMANN
Title or Position: OWNER/ VICE PRESIDENT
Credential:
Phone: 763-535-5335