Healthcare Provider Details

I. General information

NPI: 1437225497
Provider Name (Legal Business Name): CORNERSTONE MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 114TH AVE SUITE 301
LARGO FL
33773-5133
US

IV. Provider business mailing address

PO BOX 76850
ATLANTA GA
30358-1850
US

V. Phone/Fax

Practice location:
  • Phone: 727-736-7778
  • Fax: 770-392-4771
Mailing address:
  • Phone: 770-399-7337
  • Fax: 770-392-4771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW P SIMMONS SR.
Title or Position: PRESIDENT CEO
Credential:
Phone: 770-399-7337