1942351853 NPI number — DR. LINDA M SHUCK DO

Table of content: DR. LINDA M SHUCK DO (NPI 1942351853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942351853 NPI number — DR. LINDA M SHUCK DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUCK
Provider First Name:
LINDA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PLEVICH
Provider Other First Name:
LINDA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942351853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 920
Provider Second Line Business Mailing Address:
306 WHITE STREET
Provider Business Mailing Address City Name:
DOBSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27017-0920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-386-4477
Provider Business Mailing Address Fax Number:
336-386-8005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 WHITE ST
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
DOBSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27017-8938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-386-4477
Provider Business Practice Location Address Fax Number:
336-386-8005
Provider Enumeration Date:
01/16/2007

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: 207RC0000X , with the licence number:  2005-00550 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 140AV . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5901096 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37753 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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