Provider Demographics
NPI:1811877442
Name:CORNERSTONE MEDICAL GROUP OF WEST VIRGINIA LLC
Entity type:Organization
Organization Name:CORNERSTONE MEDICAL GROUP OF WEST VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JERI
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, NP-C
Authorized Official - Phone:740-590-1181
Mailing Address - Street 1:27799 STATE ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:OH
Mailing Address - Zip Code:45620-9603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:428 LEON SULLIVAN WAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1713
Practice Address - Country:US
Practice Address - Phone:681-535-2277
Practice Address - Fax:740-619-7029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty