=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003273293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORNERSTONE HEALTH COMMUNITY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2016
-----------------------------------------------------
Last Update Date | 03/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7180 E ORCHARD RD STE 306
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-1724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-452-7420
-----------------------------------------------------
Fax | 720-446-4174
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7180 E ORCHARD RD STE 306
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-1724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-452-7420
-----------------------------------------------------
Fax | 720-446-4174
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CHRISTOPHER JON MOTE SR.
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 303-770-4227
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | DR0051449
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------