Provider Demographics
NPI:1063943223
Name:MEDCORE HP
Entity type:Organization
Organization Name:MEDCORE HP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-320-2631
Mailing Address - Street 1:2609 E HAMMER LANE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210
Mailing Address - Country:US
Mailing Address - Phone:209-320-2631
Mailing Address - Fax:209-320-2653
Practice Address - Street 1:2701 E HAMMER LN
Practice Address - Street 2:SUITE 103
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-4245
Practice Address - Country:US
Practice Address - Phone:209-320-2631
Practice Address - Fax:209-320-2653
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMNI IPA MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty