Provider Demographics
NPI:1033481106
Name:MICHAEL W. MCSHAN, M.D., P.A.
Entity Type:Organization
Organization Name:MICHAEL W. MCSHAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-983-1578
Mailing Address - Street 1:1711 S HENDERSON BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-3563
Mailing Address - Country:US
Mailing Address - Phone:903-983-1578
Mailing Address - Fax:
Practice Address - Street 1:1711 S HENDERSON BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-3563
Practice Address - Country:US
Practice Address - Phone:903-983-1578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130926203Medicaid
TX00BP62Medicare PIN
TX130926203Medicaid