1003076837 NPI number — FRANK W. SHAGETS, JR., M.D., P.C.

Table of content: (NPI 1003076837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003076837 NPI number — FRANK W. SHAGETS, JR., M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANK W. SHAGETS, JR., M.D., P.C.
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:
1003076837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 W 32ND ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64804-2549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-623-5111
Provider Business Mailing Address Fax Number:
417-623-1534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 W 32ND ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-2549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-623-5111
Provider Business Practice Location Address Fax Number:
417-623-1534
Provider Enumeration Date:
06/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCCOY
Authorized Official First Name:
BETTY
Authorized Official Middle Name:
Authorized Official Title or Position:
BACK OFFICE MANAGER
Authorized Official Telephone Number:
417-623-5111

Provider Taxonomy Codes

  • Taxonomy code: 207YX0905X , with the licence number:  R8942 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DN3615 . This is a "RAILROAD MEDICARE PART B" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 202543005 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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