Provider Demographics
NPI:1982868659
Name:CORNERSTONE HEALTH CARE PA
Entity Type:Organization
Organization Name:CORNERSTONE HEALTH CARE PA
Other - Org Name:CAROLINA CARDIOLOGY CORNERSTONE - WINSTON SALEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:E
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-802-2400
Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2536
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:2150 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4241
Practice Address - Country:US
Practice Address - Phone:336-768-0437
Practice Address - Fax:336-768-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCC4241OtherRR MEDICARE
NCCC4242OtherRR MEDICARE
NCCC5472OtherRR MEDICARE
NCCF9200OtherRR MEDICARE
NCCB8658OtherRAILROAD MEDICARE
NCCC6608OtherRR MEDICARE
NCCD6614OtherRR MEDICARE
NCCC4243OtherRR MEDICARE
NC5950444Medicaid
NCCD6614OtherRR MEDICARE