Provider Demographics
NPI:1508221201
Name:CORNERSTONE INTEGRATED HEALTHCARE
Entity Type:Organization
Organization Name:CORNERSTONE INTEGRATED HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFRE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-426-1235
Mailing Address - Street 1:13355 TAMIAMI TRL
Mailing Address - Street 2:SUITE E
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2186
Mailing Address - Country:US
Mailing Address - Phone:941-426-1235
Mailing Address - Fax:941-426-4464
Practice Address - Street 1:13355 TAMIAMI TRL
Practice Address - Street 2:SUITE E
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2186
Practice Address - Country:US
Practice Address - Phone:941-426-1235
Practice Address - Fax:941-426-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty