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General NPI Number Information
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NPI Number | 1043522212
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Entity Type | Organization
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Legal Business Name | CORNERSTONE MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 07/05/2010
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Last Update Date | 07/05/2010
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Provider Practice Location Address
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Address Line | 825 N MAIN ST SUITE A
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City | HARRISON
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State | AR
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Zip | 72601-2914
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Country | US
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Telephone | 870-743-4900
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Fax | 870-743-4949
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Provider Business Mailing Address
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Address Line | 825 N MAIN ST SUITE A
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City | HARRISON
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State | AR
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Zip | 72601-2914
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Country | US
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Telephone | 870-743-4900
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Fax | 870-743-4949
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVE SHRUM
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Credential | M.D.
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Telephone | 870-743-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MC-2227
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MC-2227
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | MC-2227
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | MC-2227
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License Number State | AR
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MC-2227
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License Number State | AR
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