1194848606 NPI number — DR SCOTT L SHIELDS PC

Table of content: (NPI 1194848606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194848606 NPI number — DR SCOTT L SHIELDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR SCOTT L SHIELDS PC
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:
6
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:
1194848606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
524 N VAN BUREN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENID
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73703-4455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-237-3338
Provider Business Mailing Address Fax Number:
580-237-3399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
524 N VAN BUREN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENID
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73703-4455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-237-3338
Provider Business Practice Location Address Fax Number:
580-237-3399
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHIELDS
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
LAMAR
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
580-237-3338

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  189 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 189 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 242801356 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4800337242 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 248801356001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: OK 189 . This is a "STATE LICENSURE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 175470500 . This is a "U.S. DEPT. OF LABOR" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100779730A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1437133436 . This is a "PERSONAL NPI NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 1754470500 . This is a "WORKERS COMP." identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 243726302 . This is a "MEDICARE GRP MEMBER PTAN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 1194848606 . This is a "GROUP NPI" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 10885619 . This is a "CAQH" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200129000A . This is a "MEDICAID DME" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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