Provider Demographics
NPI:1497971816
Name:CORNERSTONE FAMILY HEALTH CARE, INC
Entity Type:Organization
Organization Name:CORNERSTONE FAMILY HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIANGELIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-516-1386
Mailing Address - Street 1:PO BOX 2470
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-2470
Mailing Address - Country:US
Mailing Address - Phone:352-516-1386
Mailing Address - Fax:352-669-0003
Practice Address - Street 1:356 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-8649
Practice Address - Country:US
Practice Address - Phone:352-516-1386
Practice Address - Fax:352-669-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103913Medicare Oscar/Certification