1992851497 NPI number — CORNERSTONE VENTURES, INC

Table of content: (NPI 1992851497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992851497 NPI number — CORNERSTONE VENTURES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE VENTURES, 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:
Provider Other Organization Name Type Code:
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:
1992851497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8870 N HIMES AVE
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33614-1627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-908-5032
Provider Business Mailing Address Fax Number:
813-908-7013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5008 W LINEBAUGH AVE
Provider Second Line Business Practice Location Address:
SUITE 22
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33624-5095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-908-5032
Provider Business Practice Location Address Fax Number:
813-908-7013
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAMPT
Authorized Official First Name:
BRADFORD
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-310-5032

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1312041 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: R8897 . This is a "BCBS FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 032180000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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