Healthcare Provider Details

I. General information

NPI: 1497130850
Provider Name (Legal Business Name): CORNERSTONE HEALTHCARE GROUP HOLDING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6198 CYPRESS ST
WEST MONROE LA
71291-9010
US

IV. Provider business mailing address

2200 ROSS AVE 5400
DALLAS TX
75201-2708
US

V. Phone/Fax

Practice location:
  • Phone: 318-396-5600
  • Fax:
Mailing address:
  • Phone: 469-621-6748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KURT SCHULTZ
Title or Position: CFO
Credential:
Phone: 469-621-6707