Basic Information
Provider Information | |||||||||
NPI: | 1629025788 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CORNERSTONE HEALTH CARE, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | PIEDMONT INTERNAL MEDICINE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1701 WESTCHSTER DRIVE | ||||||||
Address2: | SUITE 850 | ||||||||
City: | HIGH POINT | ||||||||
State: | NC | ||||||||
PostalCode: | 272627254 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3368022536 | ||||||||
FaxNumber: | 3368022534 | ||||||||
Practice Location | |||||||||
Address1: | 711 NATIONAL HWY | ||||||||
Address2: | SUITE 500 | ||||||||
City: | THOMASVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 273602633 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3364741995 | ||||||||
FaxNumber: | 3364741996 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/27/2006 | ||||||||
LastUpdateDate: | 05/27/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HILL | ||||||||
AuthorizedOfficialFirstName: | ANNE | ||||||||
AuthorizedOfficialMiddleName: | C | ||||||||
AuthorizedOfficialTitleorPosition: | BUSINESS OPERATIONS OFFICER | ||||||||
AuthorizedOfficialTelephone: | 3368022536 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | CC5472 | 01 | NC | RR MEDICARE | OTHER | CC6608 | 01 | NC | RR MEDICARE | OTHER | 269374 | 01 |   | MAMSI | OTHER | CC4243 | 01 | NC | RR MEDICARE | OTHER | 7485722 | 01 |   | AETNA | OTHER | CD6614 | 01 | NC | RR MEDICARE | OTHER | D266 | 01 | NC | PARTNERS MEDICARE CHOICE | OTHER | 02665 | 01 | NC | BCBS | OTHER | CB8658 | 01 | NC | RRMC | OTHER | 7902665 | 05 | NC |   | MEDICAID | 890047 | 01 |   | MEDCOST | OTHER | CC4241 | 01 | NC | RR MEDICARE | OTHER | CC4242 | 01 | NC | RR MEDICARE | OTHER | CF9200 | 01 | NC | RR MEDICARE | OTHER |