Healthcare Provider Details

I. General information

NPI: 1811877442
Provider Name (Legal Business Name): CORNERSTONE MEDICAL GROUP OF WEST VIRGINIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 LEON SULLIVAN WAY
CHARLESTON WV
25301-1713
US

IV. Provider business mailing address

27799 STATE ROUTE 7
CHESHIRE OH
45620-9603
US

V. Phone/Fax

Practice location:
  • Phone: 681-535-2277
  • Fax: 740-619-7029
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JERI THOMAS
Title or Position: NURSE PRACTITIONER
Credential: DNP, NP-C
Phone: 740-590-1181