1821112038 NPI number — CORNERSTONE HEALTH CARE, PA

Table of content: (NPI 1821112038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821112038 NPI number — CORNERSTONE HEALTH CARE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE HEALTH CARE, PA
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:
Provider Other Organization Name Type Code:
6
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:
1821112038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
607 IDOL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGH POINT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27262-7804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-802-2400
Provider Business Mailing Address Fax Number:
336-802-2001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
624 QUAKER LN
Provider Second Line Business Practice Location Address:
SUITE 104C
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27262-3832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-802-2397
Provider Business Practice Location Address Fax Number:
336-802-2681
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAGLE
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
DIRECTOR OF QI MANAGED CARE
Authorized Official Telephone Number:
336-802-2406

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CC5472 . This is a "RRMC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: CD6614 . This is a "RRMC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 23180 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: CB8658 . This is a "RRMC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0275Q . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: CC4241 . This is a "RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7262737 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 271662 . This is a "MAMSI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890275Q , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022 . This is a "TRICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: CF9200 . This is a "RRMC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: D266 . This is a "PARTNERS MEDICARE CHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: CC4243 . This is a "RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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