Healthcare Provider Details

I. General information

NPI: 1306883491
Provider Name (Legal Business Name): CORNERSTONE HEALTH CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 PHILLIPS AVE
HIGH POINT NC
27262-7075
US

IV. Provider business mailing address

607 IDOL ST
HIGH POINT NC
27262-7804
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2145
  • Fax: 336-802-2693
Mailing address:
  • Phone: 336-802-2400
  • Fax: 336-802-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN W CAGLE
Title or Position: DIRECTOR OF QI AND MANAGED CARE
Credential:
Phone: 336-802-2406