# CORNERSTONE HEALTH CARE INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CORNERSTONE HEALTH CARE
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1790834018
- **Legal business name:** CORNERSTONE HEALTH CARE
- **Authorized official:** VICKI L LYONS (OFFICE MANAGER)
- **Authorized official phone:** (304) 424-4129

## Contact information

- **Practice address:** 2601 DUDLEY AVE, PARKERSBURG, WV 26101-2649
- **Practice address phone:** (304) 422-9156
- **Practice address fax:** (304) 422-9159
- **Mailing address:** 2601 DUDLEY AVE, PARKERSBURG, WV 26101-2649
- **Mailing address phone:** (304) 422-9156
- **Mailing address fax:** (304) 422-9159

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01272 | WV | Yes |

## Other

- **Enumeration date:** 01/09/2007
- **Last updated:** 04/29/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0010309000 | — | WV |
| 01 | — | 001710672 | BLUE CROSS BLUE SHIELD | — |
| 05 | — | 2002102 | — | OH |
| 01 | — | CD5906 | RAILROAD MEDICARE GROUP NUMBER | — |