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General NPI Number Information
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NPI Number | 1962879965
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Entity Type | Organization
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Legal Business Name | CORK MEDICAL LLC
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 2527 DATA DR
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City | LOUISVILLE
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State | KY
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Zip | 40299-2517
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Country | US
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Telephone | 866-551-2580
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Fax |
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Provider Business Mailing Address
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Address Line | 8000 CASTLEWAY DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-1943
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Country | US
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Telephone | 317-361-4563
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | SEAN MCGINLEY
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Credential |
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Telephone | 317-361-4554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 331488
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License Number State | KY
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