Provider Demographics
NPI:1003076837
Name:FRANK W. SHAGETS, JR., M.D., P.C.
Entity Type:Organization
Organization Name:FRANK W. SHAGETS, JR., M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BACK OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:CST, MA
Authorized Official - Phone:417-623-5111
Mailing Address - Street 1:620 W 32ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2549
Mailing Address - Country:US
Mailing Address - Phone:417-623-5111
Mailing Address - Fax:417-623-1534
Practice Address - Street 1:620 W 32ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2549
Practice Address - Country:US
Practice Address - Phone:417-623-5111
Practice Address - Fax:417-623-1534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8942207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODN3615OtherRAILROAD MEDICARE PART B
MO202543005Medicaid
MOMA1133Medicare PIN
MO202543005Medicaid