Healthcare Provider Details

I. General information

NPI: 1063464964
Provider Name (Legal Business Name): CORNERSTONE MEDICAL CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N MAIN ST.
HARRISON AR
72601
US

IV. Provider business mailing address

825 N MAIN ST.
HARRISON AR
72601
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 TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberMC2227
License Number StateAR

VIII. Authorized Official

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