Provider Demographics
NPI:1750439204
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:740-423-5535
Mailing Address - Street 1:204 STONE RD
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-2348
Mailing Address - Country:US
Mailing Address - Phone:740-423-5535
Mailing Address - Fax:740-423-5254
Practice Address - Street 1:204 STONE RD
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-2348
Practice Address - Country:US
Practice Address - Phone:740-423-5535
Practice Address - Fax:740-423-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1390252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN4410OtherRAILROAD MEDICARE GROUP NUMBER
WV0010309000Medicaid
001710673OtherBLUE CROSS BLUE SHIELD
OH2002102Medicaid
9287215Medicare PIN
CN4410OtherRAILROAD MEDICARE GROUP NUMBER