Provider Demographics
NPI:1700853553
Name:CORNERSTONE CLINIC FOR WOMEN
Entity Type:Organization
Organization Name:CORNERSTONE CLINIC FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-224-5500
Mailing Address - Street 1:9500 BAPTIST HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6319
Mailing Address - Country:US
Mailing Address - Phone:501-224-5500
Mailing Address - Fax:501-224-1166
Practice Address - Street 1:9500 BAPTIST HEALTH DR STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6319
Practice Address - Country:US
Practice Address - Phone:501-224-5500
Practice Address - Fax:501-224-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC0427261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5409551OtherAETNA
AR164172002Medicaid
AR57069Medicare PIN
AR164172002Medicaid