Provider Demographics
NPI:1033267885
Name:CORNERSTONE UNIVERSITY HEALTH SERVICES
Entity Type:Organization
Organization Name:CORNERSTONE UNIVERSITY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-222-1441
Mailing Address - Street 1:1001 E BELTLINE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-5803
Mailing Address - Country:US
Mailing Address - Phone:616-222-1441
Mailing Address - Fax:616-222-1541
Practice Address - Street 1:1001 E BELTLINE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-5803
Practice Address - Country:US
Practice Address - Phone:616-222-1441
Practice Address - Fax:616-222-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI80-0-D1-1180-0OtherBCBS PIN