| Cornerstone Family Medical Center Llc | |
|
111 Alabama St Columbus MS 39702-5220 | |
| (662) 570-4636 | |
| Not Available |
| Full Name | Cornerstone Family Medical Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 111 Alabama St, Columbus, Mississippi |
| Authorized Official Name and Position | Cindy Vaughan (OWNER) |
| Authorized Official Contact | 6625704636 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cornerstone Family Medical Center Llc 111 Alabama St Columbus MS 39702-5220 Ph: (662) 570-4636 | Cornerstone Family Medical Center Llc 111 Alabama St Columbus MS 39702-5220 Ph: (662) 570-4636 |
| NPI Number | 1255097333 |
|---|---|
| Provider Enumeration Date | 11/12/2021 |
| Last Update Date | 11/12/2021 |
| Medicare PECOS PAC ID | 4385035278 |
|---|---|
| Medicare Enrollment ID | O20220104001228 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255097333 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Charlene Luecinda Vaughan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790035731 PECOS PAC ID: 6204081045 Enrollment ID: I20130301000053 |
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