| Name: | CORE ENT, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 02 May 2012 (13 years ago) |
| Entity Number: | 000-054-538 |
| Register Number: | 000054538 |
| County: | Etowah |
| Place of Formation: | Etowah County |
| Registered Office Street Address: | 215 SOUTH 5TH STREETGADSDEN, AL 35901 |
| Registered Office Street Address ZIP Code: | 35901 |
Activities
PROVIDE MEDICAL AND HEALTH CARE SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649523044 | 2012-10-23 | 2012-10-23 | PO BOX 8365, GADSDEN, AL, 359028365, US | 215 SOUTH 5TH STREET, GADSDEN, AL, 359014217, US | |||||||||||||||||||||||||
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| Phone | +1 256-543-2867 |
| Fax | 2564594791 |
Authorized person
| Name | KURT W. KANTZLER |
| Role | PHYSICIAN |
| Phone | 2565432867 |
Taxonomy
| Taxonomy Code | 207YX0905X - Otolaryngology/Facial Plastic Surgery Physician |
| License Number | D0637 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 123503 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| KANTZLER, KURT W | Agent | 215 SOUTH 5TH STREETGADSDEN, AL 35901 |
| Name | Role | Address |
|---|---|---|
| KANTZLER, KURT W | Organizer | 215 SOUTH 5TH STREETGADSDEN, AL 35901 |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
