1184790149 NPI number — CORNERSTONE MEDICAL INC

Table of content: (NPI 1184790149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184790149 NPI number — CORNERSTONE MEDICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE MEDICAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CORNERSTONE PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184790149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 76850
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30358-1850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-399-7337
Provider Business Mailing Address Fax Number:
770-392-4771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9694 MADISON BLVD
Provider Second Line Business Practice Location Address:
SUITE A5
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35758-9161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-772-3077
Provider Business Practice Location Address Fax Number:
770-392-4771
Provider Enumeration Date:
11/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SIMMONS
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
770-399-7337

Provider Taxonomy Codes

  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)