Basic Information
| Provider Information | |||||||||
| NPI: | 1275666125 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CORNERSTONE HEALTH CARE, PA | ||||||||
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| OtherOrganizationName: | R. VAN FLETCHER, MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 WESTCHESTER DRIVE | ||||||||
| Address2: | SUITE 850 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272627254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022536 | ||||||||
| FaxNumber: | 3368022534 | ||||||||
| Practice Location | |||||||||
| Address1: | 721 N ELM ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272623928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022010 | ||||||||
| FaxNumber: | 3368022011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 11/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | TERRELL | ||||||||
| AuthorizedOfficialFirstName: | GRACE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT / CEO | ||||||||
| AuthorizedOfficialTelephone: | 3368022400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 890246R | 05 | NC | MEDICAID | CC4241 | 01 | NC | RR MEDICARE | OTHER | CC4242 | 01 | NC | RR MEDICARE | OTHER | CD6614 | 01 | NC | RR MEDICARE | OTHER | 22742 | 01 | MEDCOST | OTHER | 7100720 | 01 | AETNA | OTHER | CC4243 | 01 | NC | RR MEDICARE | OTHER | 0246R | 01 | NC | BCBS | OTHER | CC5472 | 01 | NC | RRMC | OTHER | CC6608 | 01 | NC | RR MEDICARE | OTHER | D266 | 01 | NC | PARTNERS MEDICARE CHOICE | OTHER | 269374 | 01 | MAMSI | OTHER | CB8658 | 01 | NC | RR MEDICARE | OTHER | CF9200 | 01 | NC | RR MEDICARE | OTHER |