1982834552 NPI number — CORNERSTONE FAMILY PRACTICE, INC.

Table of content: (NPI 1982834552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982834552 NPI number — CORNERSTONE FAMILY PRACTICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE FAMILY PRACTICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982834552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3371 BLUE SPRINGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRAWBERRY PLAINS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37871-3848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-617-5081
Provider Business Mailing Address Fax Number:
865-465-9098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1171 W HIGHWAY 11E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW MARKET
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37820-4106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-262-9095
Provider Business Practice Location Address Fax Number:
865-262-9098
Provider Enumeration Date:
07/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HENSLEY
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
RUTH
Authorized Official Title or Position:
PRESIDENT- NURSE PRACTITIONER
Authorized Official Telephone Number:
865-262-9095

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  12228 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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