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General NPI Number Information
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NPI Number | 1245389568
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Entity Type | Organization
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Legal Business Name | CORNERSTONE HEALTH CARE INC.
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 201 LAFAYETTE ST
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City | SAINT MARYS
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State | WV
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Zip | 26170-1027
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Country | US
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Telephone | 304-684-2267
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Fax | 304-684-2532
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Provider Business Mailing Address
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Address Line | 201 LAFAYETTE ST
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City | SAINT MARYS
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State | WV
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Zip | 26170-1027
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Country | US
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Telephone | 304-684-2267
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Fax | 304-684-2532
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | VICKI L LYONS
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Credential |
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Telephone | 304-424-4219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01272
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License Number State | WV
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