MEDICARE: CORE MD MANAGMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse

General Provider Information

NPI Number	:	1467943142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE MD MANAGMENT LLC

Provider Business Mailing Address
First Line	:	19875 SOUTHWEST FWY STE 110
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19875 SOUTHWEST FWY STE 100
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3502
Country	:	US
Telephone Number	:	281-849-6988
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS MARY ROSE AGUSTIN
Credential	:	NP
Telephone Number	:	281-849-6988

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	05/29/2018

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