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NPI Code Detail

MEDICARE: CORNERSTONE UNIVERSITY HEALTH SERVICES

MEDICARE: CORNERSTONE UNIVERSITY HEALTH SERVICES
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
1261QS1000XStudent Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
180-0-D1-1180-0OTHERMIBCBS PIN

General Provider Information

NPI Number : 1033267885
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORNERSTONE UNIVERSITY HEALTH SERVICES
Provider Business Mailing Address
First Line : 1001 E BELTLINE AVE NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-5803
Country : US
Telephone Number : 616-222-1441
Fax Number : 616-222-1541
Provider Business Practice Location Address
First Line : 1001 E BELTLINE AVE NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-5803
Country : US
Telephone Number : 616-222-1441
Fax Number : 616-222-1541
Authorized Official
Title or Position : OFFICE MANAGER
Name : CAROL LEE CARPENTER
Credential :
Telephone Number : 616-222-1441
Provider Enumeration Date : 01/08/2007
Last Update Date : 05/19/2009

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Directions to “CORNERSTONE UNIVERSITY HEALTH SERVICES ” Practice Location

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