1184830580 NPI number — MS. SHEILA LEE SHIPMAN IDC

Table of content: MS. SHEILA LEE SHIPMAN IDC (NPI 1184830580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184830580 NPI number — MS. SHEILA LEE SHIPMAN IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIPMAN
Provider First Name:
SHEILA
Provider Middle Name:
LEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
IDC
Provider Gender Code:
F

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:
1184830580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3513 BEASLEY RD APT 5F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAUTIER
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39553-5032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-383-5888
Provider Business Mailing Address Fax Number:
228-871-2135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NMCB SEVEN
Provider Second Line Business Practice Location Address:
UNIT 60252
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
34099-5061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-871-2810
Provider Business Practice Location Address Fax Number:
228-871-2135
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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