Provider Demographics
NPI:1568668481
Name:CORNERSTONE CLINICAL SERVICES, INC
Entity Type:Organization
Organization Name:CORNERSTONE CLINICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:580-595-7000
Mailing Address - Street 1:1408 W ELDER AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-4022
Mailing Address - Country:US
Mailing Address - Phone:580-470-8898
Mailing Address - Fax:580-786-2786
Practice Address - Street 1:1408 W ELK AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-3736
Practice Address - Country:US
Practice Address - Phone:580-595-7000
Practice Address - Fax:580-595-7005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNERSTONE CLINICAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-26
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100747400A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100747400AMedicaid