Provider Demographics
NPI:1952571028
Name:CORNERSTONE AMBULATORY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:CORNERSTONE AMBULATORY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHOKKUMAR
Authorized Official - Middle Name:SHIVSHANKAR
Authorized Official - Last Name:THANKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-752-4040
Mailing Address - Street 1:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-0759
Mailing Address - Country:US
Mailing Address - Phone:215-752-4040
Mailing Address - Fax:215-752-5348
Practice Address - Street 1:3 CORNERSTONE DR
Practice Address - Street 2:SUITE 704
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1320
Practice Address - Country:US
Practice Address - Phone:215-752-7080
Practice Address - Fax:215-752-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA21331501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102259548 0001Medicaid
PA39C0001269Medicare Oscar/Certification