Provider Demographics
NPI:1861809089
Name:KORT MEDICAL SUPPLY
Entity type:Organization
Organization Name:KORT MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KORT
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT-R
Authorized Official - Phone:214-714-3042
Mailing Address - Street 1:6101 SAINTSBURY DR APT 632
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5217
Mailing Address - Country:US
Mailing Address - Phone:214-714-3042
Mailing Address - Fax:
Practice Address - Street 1:6101 SAINTSBURY DR APT 632
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056
Practice Address - Country:US
Practice Address - Phone:214-714-3042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX211042183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty