Basic Information
| Provider Information | |||||||||
| NPI: | 1821112038 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CORNERSTONE HEALTH CARE, PA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | THE IMAGING CENTER - QUAKER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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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: | 624 QUAKER LN | ||||||||
| Address2: | SUITE 104C | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272623832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022397 | ||||||||
| FaxNumber: | 3368022681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 03/25/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CAGLE | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF QI MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 3368022406 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | CC5472 | 01 | NC | RRMC | OTHER | CD6614 | 01 | NC | RRMC | OTHER | 23180 | 01 | NC | MEDCOST | OTHER | CB8658 | 01 | NC | RRMC | OTHER | 0275Q | 01 | NC | BCBS | OTHER | CC4241 | 01 | NC | RR MEDICARE | OTHER | 7262737 | 01 | NC | AETNA | OTHER | 271662 | 01 | NC | MAMSI | OTHER | 890275Q | 05 | NC | MEDICAID | 022 | 01 | NC | TRICARE | OTHER | CF9200 | 01 | NC | RRMC | OTHER | D266 | 01 | NC | PARTNERS MEDICARE CHOICE | OTHER | CC4243 | 01 | NC | RR MEDICARE | OTHER |