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General NPI Number Information
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NPI Number | 1780828806
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Entity Type | Organization
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Legal Business Name | CORNER MEDICAL LLC
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Dates
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Enumeration Date | 04/21/2009
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Last Update Date | 11/20/2017
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Provider Practice Location Address
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Address Line | 9720 HUMBOLDT AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55431-2623
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Country | US
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Telephone | 952-388-0500
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Fax | 952-388-0444
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Provider Business Mailing Address
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Address Line | 2730 NEVADA AVE N
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City | NEW HOPE
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State | MN
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Zip | 55427-2807
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Country | US
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Telephone | 763-535-5335
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Fax | 952-388-0444
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAN STEINHAUSER
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Credential |
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Telephone | 763-535-5335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 361419
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License Number State | MN
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