Healthcare Provider Details

I. General information

NPI: 1639490345
Provider Name (Legal Business Name): CORNERSTONE CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 SW F AVE
LAWTON OK
73501-4506
US

IV. Provider business mailing address

807 SW F AVE
LAWTON OK
73501-4506
US

V. Phone/Fax

Practice location:
  • Phone: 580-595-7000
  • Fax:
Mailing address:
  • Phone: 580-595-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. FELICIA HARRIS
Title or Position: BHRS
Credential:
Phone: 580-699-5185