Provider Demographics
NPI:1376523449
Name:CORNERSTONE FAMILY HEALTH, PC
Entity Type:Organization
Organization Name:CORNERSTONE FAMILY HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REDKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-326-4118
Mailing Address - Street 1:1205 GRAMPIAN BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1978
Mailing Address - Country:US
Mailing Address - Phone:570-326-4118
Mailing Address - Fax:570-326-5533
Practice Address - Street 1:1205 GRAMPIAN BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1978
Practice Address - Country:US
Practice Address - Phone:570-326-4118
Practice Address - Fax:570-326-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA020833OtherAMERIHEALTH
PA020833OtherHIGHMARK BLUE SHIELD
PA85252OtherAETNA
PA0006325900001Medicaid
PA1002OtherFIRST PRIORITY HEALTH
PAC74266OtherPALMETTO/MC RAILROAD
PA1002OtherFIRST PRIORITY HEALTH