Basic Information
| Provider Information | |||||||||
| NPI: | 1588789580 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CORNERSTONE HEALTH CARE, PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CORNERSTONE URGENT CARE HIGH POINT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 607 IDOL ST | ||||||||
| Address2: | |||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272627804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022400 | ||||||||
| FaxNumber: | 3368022001 | ||||||||
| Practice Location | |||||||||
| Address1: | 611 N LINDSAY ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272624300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022222 | ||||||||
| FaxNumber: | 3368022151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | CAGLE | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF QI MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 3368022406 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 89011P7 | 05 | NC | MEDICAID | CC4241 | 01 | NC | RR MEDICARE | OTHER | CC4243 | 01 | NC | RR MEDICARE | OTHER | CD6614 | 01 | NC | RR MEDICARE | OTHER | 25864 | 01 | NC | MEDCOST | OTHER | CB8658 | 01 | NC | RR MEDICARE | OTHER | 7624749 | 01 | NC | AETNA | OTHER | 011P7 | 01 | NC | BCBS | OTHER | D266 | 01 | NC | PARTNERS | OTHER |