Healthcare Provider Details

I. General information

NPI: 1043522212
Provider Name (Legal Business Name): CORNERSTONE MEDICAL CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2010
Last Update Date: 07/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N MAIN ST SUITE A
HARRISON AR
72601-2914
US

IV. Provider business mailing address

825 N MAIN ST SUITE A
HARRISON AR
72601-2914
US

V. Phone/Fax

Practice location:
  • Phone: 870-743-4900
  • Fax: 870-743-4949
Mailing address:
  • Phone: 870-743-4900
  • Fax: 870-743-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMC-2227
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMC-2227
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberMC-2227
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberMC-2227
License Number StateAR
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMC-2227
License Number StateAR

VIII. Authorized Official

Name: DR. STEVE SHRUM
Title or Position: OWNER
Credential: M.D.
Phone: 870-743-4900