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General NPI Number Information
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NPI Number | 1205689171
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Entity Type | Organization
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Legal Business Name | CORNER HEALTH MEDICAL GROUP P A
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Dates
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Enumeration Date | 04/09/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 2 N CENTRAL AVE
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City | PHOENIX
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State | AZ
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Zip | 85004-2322
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Country | US
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Telephone | 602-123-4567
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Fax |
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Provider Business Mailing Address
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Address Line | 312 ARIZONA AVE STE 314
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City | SANTA MONICA
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State | CA
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Zip | 90401-1306
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Country | US
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Telephone | 404-860-3441
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LAVANYA SUNDER
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Credential |
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Telephone | 404-860-3441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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