Provider Demographics
NPI:1003273293
Name:CORNERSTONE HEALTH COMMUNITY PC
Entity Type:Organization
Organization Name:CORNERSTONE HEALTH COMMUNITY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JON
Authorized Official - Last Name:MOTE
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:303-770-4227
Mailing Address - Street 1:7180 E ORCHARD RD
Mailing Address - Street 2:STE 306
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1724
Mailing Address - Country:US
Mailing Address - Phone:720-452-7420
Mailing Address - Fax:720-446-4174
Practice Address - Street 1:7180 E ORCHARD RD
Practice Address - Street 2:STE 306
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-1724
Practice Address - Country:US
Practice Address - Phone:720-452-7420
Practice Address - Fax:720-446-4174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0051449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO475232OtherMEDICARE