MEDICARE: CORNERSTONE HOSPICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	4146	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	371606	OTHER	OK	MEDICARE PROVIDER NUMBER

General Provider Information

NPI Number	:	1922009315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE HOSPICE LLC

Provider Business Mailing Address
First Line	:	501 E 5TH ST STE A
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74003-3942
Country	:	US
Telephone Number	:	918-213-4973
Fax Number	:	918-213-4989

Provider Business Practice Location Address
First Line	:	501 E 5TH ST STE A
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74003-3942
Country	:	US
Telephone Number	:	918-213-4973
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. MICHAEL BRENT MOORE
Credential	:	R PH D
Telephone Number	:	918-213-4973

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/28/2022

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Directions to “CORNERSTONE HOSPICE LLC ” Practice Location

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