Organization
CORNERSTONE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORINDA A MARCEAUX (MANAGER)
(253) 241-3401
Entity
Organization
Contact information
Practice address
1420 MAIN ST, SUMNER, WA 98390-1810
(253) 987-5156
(253) 987-5462
Mailing address
1420 MAIN ST, SUMNER, WA 98390-1810
(253) 987-5156
(253) 987-5462
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00036169
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0185591
L & I
WA
01
—
5496722
AETNA
WA
05
—
8232878
—
WA
01
—
911203494BP
KPS
WA
01
—
98390A015
TRICARE
WA
01
—
9869DA
REGENCE RIDER
WA
Enumeration date
01/25/2010
Last updated
01/25/2010
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