Basic Information
| Provider Information | |||||||||
| NPI: | 1982868659 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORNERSTONE HEALTH CARE PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CAROLINA CARDIOLOGY CORNERSTONE - WINSTON SALEM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 WESTCHESTER DRIVE | ||||||||
| Address2: | SUITE 850 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272627254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022536 | ||||||||
| FaxNumber: | 3368022534 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 COUNTRY CLUB RD | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271044241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367680437 | ||||||||
| FaxNumber: | 3367680433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2008 | ||||||||
| LastUpdateDate: | 06/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | TERRELL | ||||||||
| AuthorizedOfficialFirstName: | GRACE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT / CEO | ||||||||
| AuthorizedOfficialTelephone: | 3368022400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | CC4241 | 01 | NC | RR MEDICARE | OTHER | CC4242 | 01 | NC | RR MEDICARE | OTHER | CC5472 | 01 | NC | RR MEDICARE | OTHER | CF9200 | 01 | NC | RR MEDICARE | OTHER | CB8658 | 01 | NC | RAILROAD MEDICARE | OTHER | CC6608 | 01 | NC | RR MEDICARE | OTHER | CD6614 | 01 | NC | RR MEDICARE | OTHER | CC4243 | 01 | NC | RR MEDICARE | OTHER | 5950444 | 05 | NC | MEDICAID |