Provider Demographics
NPI:1104940923
Name:CORNERSTONE HEALTH CARE, PA
Entity type:Organization
Organization Name:CORNERSTONE HEALTH CARE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:E
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-802-2400
Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2536
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:400 N ELM ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4939
Practice Address - Country:US
Practice Address - Phone:336-802-2120
Practice Address - Fax:336-802-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCF9200OtherRR MEDICARE
NCD266OtherPARTNERS MEDICARE CHOICE
NCCC4241OtherRR MEDICARE
NCCC5472OtherRRMC
NCCD6614OtherRR MEDICARE
NC890246VMedicaid
NCCC4242OtherRR MEDICARE
NCCC6608OtherRR MEDICARE
NCCC4243OtherRR MEDICARE
7884759OtherAETNA
NC0246VOtherBCBS
22798OtherMEDCOST
269374OtherMAMSI
NCCB8658OtherRR MEDICARE
NC890246VMedicaid
NCCB8658OtherRR MEDICARE
NCCC5472OtherRRMC