Basic Information
| Provider Information | |||||||||
| NPI: | 1295357804 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORNERSTONE HEALTHCARE GROUP HOLDING INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 ROSS AVE STE 5400 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752017918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696216700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 351 S 40TH ST | ||||||||
| Address2: | |||||||||
| City: | MUSKOGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744014916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186826161 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2020 | ||||||||
| LastUpdateDate: | 05/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCHULTZ | ||||||||
| AuthorizedOfficialFirstName: | KURT | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4696216700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.