Provider Demographics
NPI:1902914419
Name:MED-CORE SERVICES INC
Entity Type:Organization
Organization Name:MED-CORE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:360-705-0122
Mailing Address - Street 1:6706 MARTIN WAY E
Mailing Address - Street 2:SUITE #1
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5540
Mailing Address - Country:US
Mailing Address - Phone:866-225-4800
Mailing Address - Fax:866-223-1200
Practice Address - Street 1:6706 MARTIN WAY E
Practice Address - Street 2:SUITE #1
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-5540
Practice Address - Country:US
Practice Address - Phone:866-225-4800
Practice Address - Fax:866-223-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALR00002535332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9053091Medicaid
WA9053091Medicaid
WV=========OtherEIN