Provider Demographics
NPI:1073534095
Name:CORNERSTONE DIABETES AND MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:CORNERSTONE DIABETES AND MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-536-2500
Mailing Address - Street 1:4165 MILLERSVILLE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2989
Mailing Address - Country:US
Mailing Address - Phone:317-536-2500
Mailing Address - Fax:317-546-2501
Practice Address - Street 1:4165 MILLERSVILLE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2989
Practice Address - Country:US
Practice Address - Phone:317-536-2500
Practice Address - Fax:317-546-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5635970001Medicare NSC