Provider Demographics
NPI:1053640029
Name:CORNERSTONE PROSTHETICS AND ORTHOTICS, INC
Entity Type:Organization
Organization Name:CORNERSTONE PROSTHETICS AND ORTHOTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:425-339-2559
Mailing Address - Street 1:1300 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2200
Mailing Address - Country:US
Mailing Address - Phone:425-339-2559
Mailing Address - Fax:
Practice Address - Street 1:566 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3079
Practice Address - Country:US
Practice Address - Phone:360-797-1001
Practice Address - Fax:360-797-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600596756335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA027038001OtherGROUP HEALTH
WA2006562Medicaid
WA9004717Medicaid
WA9018516Medicaid
WA91118OtherLABOR AND INDUSTRIES
WA1053640029OtherMEDICARE NPI
WA192166200OtherOWCP
WA192166200OtherOWCP
WA91118OtherLABOR AND INDUSTRIES
WA=========OtherAETNA
WA=========OtherCHOICE CARE