Basic Information
| Provider Information | |||||||||
| NPI: | 1215156781 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHG CORNERSTONE HOSPITAL OF AUSTIN | ||||||||
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| OtherOrganizationName: | CORNERSTONE HOSPITAL OF AUSTIN AT ST. DAVID'S HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13455 NOEL RD | ||||||||
| Address2: | SUITE 1320 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752406620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696216700 | ||||||||
| FaxNumber: | 4696216672 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 E 32ND ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787052713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128675470 | ||||||||
| FaxNumber: | 5128675424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 12/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | SNIDER | ||||||||
| AuthorizedOfficialFirstName: | STACIE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4696216715 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | 008280 | TX | Y | Hospitals | Long Term Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1820730-01 | 05 | TX | MEDICAID |