Provider Demographics
NPI:1063464964
Name:CORNERSTONE MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:CORNERSTONE MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHRUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-743-4900
Mailing Address - Street 1:825 N MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601
Mailing Address - Country:US
Mailing Address - Phone:870-743-4900
Mailing Address - Fax:870-743-4949
Practice Address - Street 1:825 N MAIN ST.
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601
Practice Address - Country:US
Practice Address - Phone:870-743-4900
Practice Address - Fax:870-743-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC2227261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149189002Medicaid
5C727Medicare PIN