Basic Information
| Provider Information | |||||||||
| NPI: | 1992942411 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CORNERSTONE HEALTH CARE, PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PIEDMONT PLASTIC SURGERY | ||||||||
| 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: | 3368022400 | ||||||||
| FaxNumber: | 3368022001 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 NORTH LINDSAY STREET | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272623945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368861667 | ||||||||
| FaxNumber: | 3368865536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2009 | ||||||||
| LastUpdateDate: | 09/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | BECK | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3368022440 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | CC4243 | 01 | NC | RR MEDICARE | OTHER | CF9200 | 01 | NC | RR MEDICARE | OTHER | CC4242 | 01 | NC | RR MEDICARE | OTHER | 5912094 | 05 | NC | MEDICAID | CB8658 | 01 | NC | RR MEDICARE | OTHER | CC6608 | 01 | NC | RR MEDICARE | OTHER | CC4241 | 01 | NC | RR MEDICARE | OTHER | CC5472 | 01 | NC | RR MEDICARE | OTHER | CD6614 | 01 | NC | RR MEDICARE | OTHER |