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General NPI Number Information
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NPI Number | 1356126486
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Entity Type | Organization
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Legal Business Name | CORNERSTONE URGENT CARE & FAMILY MEDICINE
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 32 DAVID THOMPSON DR STE A
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City | BONNERS FERRY
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State | ID
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Zip | 83805-4948
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Country | US
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Telephone | 208-267-3934
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 325
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City | BONNERS FERRY
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State | ID
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Zip | 83805-0325
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Country | US
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Telephone | 208-367-3934
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. RYAN GORMAN
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Credential | DNP, NP-C
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Telephone | 208-267-3934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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