Provider Demographics
NPI:1114022498
Name:SHIRLEY EYMAN
Entity Type:Organization
Organization Name:SHIRLEY EYMAN
Other - Org Name:SHIRLEY EYMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:364-573-2007
Mailing Address - Street 1:1206 HOMELIFE PLZ
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2512
Mailing Address - Country:US
Mailing Address - Phone:573-364-2007
Mailing Address - Fax:573-364-8695
Practice Address - Street 1:1206 HOMELIFE PLZ
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2512
Practice Address - Country:US
Practice Address - Phone:573-364-2007
Practice Address - Fax:573-364-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001002473273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0205785918Medicaid
MO0205785918Medicaid
MOG24759Medicare UPIN