Provider Demographics
NPI:1619003654
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 DR
Mailing Address - Street 2:STE 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 1:3057 TRENWEST DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3220
Practice Address - Country:US
Practice Address - Phone:336-765-0710
Practice Address - Fax:336-765-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCC4243OtherRR MEDICARE
NC5905367Medicaid
NCCF9200OtherRR MEDICARE
NCD266OtherPARTNERS
NC0007221327OtherAETNA
NCCB8658OtherRR MEDICARE
NCCC5472OtherRR MEDICARE
NCCC4241OtherRR MEDICARE
NC128771OtherMEDCOST
NC5911374Medicaid
NCCC4242OtherRR MEDICARE
NCCD6614OtherRR MEDICARE
NC018N7OtherBCBS
NCCC6608OtherRR MEDICARE
NCCF9200OtherRR MEDICARE
NC=========062OtherTRICARE
NCCF9200OtherRR MEDICARE