Provider Demographics
NPI:1245389568
Name:CORNERSTONE HEALTH CARE INC.
Entity Type:Organization
Organization Name:CORNERSTONE HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-424-4219
Mailing Address - Street 1:201 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:WV
Mailing Address - Zip Code:26170-1027
Mailing Address - Country:US
Mailing Address - Phone:304-684-2267
Mailing Address - Fax:304-684-2532
Practice Address - Street 1:201 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:WV
Practice Address - Zip Code:26170-1027
Practice Address - Country:US
Practice Address - Phone:304-684-2267
Practice Address - Fax:304-684-2532
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNERSTONE HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-09
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0010309001Medicaid
001710672OtherBLUE CROSS BLUE SHIELD
OH2002102Medicaid
CD5906OtherRAILROAD MEDICARE GROUP NUMBER
WV0010309001Medicaid