Organization Name: | CORNERSTONE MEDICAL CLINIC PLLC |
NPI Number: | 1043522212 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STEVE SHRUM (OWNER) |
Mailing Address: | 825 N Main St Suite A Harrison |
State: | AR US |
Postal Code: | 726012914 |
Phone Number: | 8707434900 |
Fax Number: | 8707434949 |
NPI Enumeration Date: | 07/05/2010 |
NPI Last Update Date: | 07/05/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | MC-2227 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |