Basic Information
| Provider Information | |||||||||
| NPI: | 1851416671 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CORNERSTONE HEALTH CARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EMERYWOOD MEDICAL SPECIALTIES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 WESTCHESTER DRIVE | ||||||||
| Address2: | SUITE 850 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272627804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022536 | ||||||||
| FaxNumber: | 3368022534 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 N LINDSAY ST | ||||||||
| Address2: | |||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272623902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022060 | ||||||||
| FaxNumber: | 3368022061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 05/27/2016 | ||||||||
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| AuthorizedOfficialLastName: | HILL | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS SERVICES OPERATION OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3368022536 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RR0500X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RE0101X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | CC4241 | 01 | NC | RR MEDICARE | OTHER | D266 | 01 | NC | PARTNERS MEDICARE CHOICE | OTHER | CC4243 | 01 | NC | RR MEDICARE | OTHER | CC5472 | 01 | NC | RR MEDICARE | OTHER | 890246N | 05 | NC | MEDICAID | CF9200 | 01 | NC | RR MEDICARE | OTHER | 1212660005 | 01 | NC | DME | OTHER | 30074 | 01 | MEDCOST | OTHER | CD6614 | 01 | NC | RR MEDICARE | OTHER | 0246N | 01 | NC | BCBS | OTHER | 7310733 | 01 | AETNA | OTHER | CC4242 | 01 | NC | RR MEDICARE | OTHER | CB8658 | 01 | NC | RRMC | OTHER | CC6608 | 01 | NC | RR MEDICARE | OTHER |