Provider Demographics
NPI:1922009315
Name:CORNERSTONE HOSPICE LLC
Entity Type:Organization
Organization Name:CORNERSTONE HOSPICE LLC
Other - Org Name:CORNERSTONE HOSPICE OF TULSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:R PH D
Authorized Official - Phone:918-213-4973
Mailing Address - Street 1:501 E 5TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-3942
Mailing Address - Country:US
Mailing Address - Phone:918-213-4973
Mailing Address - Fax:918-213-4989
Practice Address - Street 1:501 E 5TH ST STE A
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-3942
Practice Address - Country:US
Practice Address - Phone:918-213-4973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4146251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371606OtherMEDICARE PROVIDER NUMBER
371606Medicare UPIN
371606Medicare Oscar/Certification