Provider Demographics
NPI:1780810259
Name:CORNERSTONE PAIN MANAGEMENT
Entity type:Organization
Organization Name:CORNERSTONE PAIN MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:WINFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:SARDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-419-9108
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:TX
Mailing Address - Zip Code:75459-0837
Mailing Address - Country:US
Mailing Address - Phone:817-419-9108
Mailing Address - Fax:817-419-3336
Practice Address - Street 1:501 N. RITA LN
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014
Practice Address - Country:US
Practice Address - Phone:817-419-9108
Practice Address - Fax:817-419-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6619207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210824301Medicaid
TX0A5006Medicare UPIN
TX0A5006Medicare PIN