Healthcare Provider Details

I. General information

NPI: 1053640029
Provider Name (Legal Business Name): CORNERSTONE PROSTHETICS AND ORTHOTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 N 5TH AVE
SEQUIM WA
98382-3079
US

IV. Provider business mailing address

1300 44TH ST SE
EVERETT WA
98203-2200
US

V. Phone/Fax

Practice location:
  • Phone: 360-797-1001
  • Fax: 360-797-1003
Mailing address:
  • Phone: 425-339-2559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number600596756
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier027038001
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerGROUP HEALTH
# 2
Identifier2006562
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 3
Identifier9004717
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 4
Identifier9018516
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 5
Identifier91118
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerLABOR AND INDUSTRIES
# 6
Identifier1053640029
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerMEDICARE NPI
# 7
Identifier192166200
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerOWCP

VIII. Authorized Official

Name: MR. DAVID J HUGHES
Title or Position: PRESIDENT
Credential: CPO
Phone: 425-339-2559