Provider Demographics
NPI:1720103609
Name:CORNERSTONE HEALTH CARE PA
Entity Type:Organization
Organization Name:CORNERSTONE HEALTH CARE PA
Other - Org Name:CORNERSTONE CONVENIENCE CARE CLINIC AT PREMIER
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:MD
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 1:4515 PREMIER DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8350
Practice Address - Country:US
Practice Address - Phone:336-802-2222
Practice Address - Fax:336-802-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890281LMedicaid
NCCB8658OtherRR MEDICARE
NCD266OtherPARTNERS
NC25864OtherMEDCOST
NC0281LOtherBCBS
NC7030772OtherAETNA
NCCC4243OtherRR MEDICARE
NCCC4241OtherRR MEDICARE
NCCD6614OtherRR MEDICARE
NCCC4241OtherRR MEDICARE
NC2318873IMedicare PIN
NC2318873Medicare PIN