Provider Demographics
NPI:1790167070
Name:WS CHIEF CORNERSTONE INC.
Entity Type:Organization
Organization Name:WS CHIEF CORNERSTONE INC.
Other - Org Name:PREMIER OCCUPATIONAL MEDICINE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:DION
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-492-4071
Mailing Address - Street 1:1080 N INDIAN CANYON DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4869
Mailing Address - Country:US
Mailing Address - Phone:760-864-1000
Mailing Address - Fax:760-864-1093
Practice Address - Street 1:1080 N INDIAN CANYON DR
Practice Address - Street 2:SUITE 206
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4869
Practice Address - Country:US
Practice Address - Phone:760-864-1000
Practice Address - Fax:760-864-1093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WS CHIEF CORNERSTONE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC508452083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty