Provider Demographics
NPI:1194848606
Name:DR SCOTT L SHIELDS PC
Entity Type:Organization
Organization Name:DR SCOTT L SHIELDS PC
Other - Org Name:TOTAL FOOT & ANKLE
Other - Org Type:Other Name
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:580-237-3338
Mailing Address - Street 1:524 N VAN BUREN
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-4455
Mailing Address - Country:US
Mailing Address - Phone:580-237-3338
Mailing Address - Fax:580-237-3399
Practice Address - Street 1:524 N VAN BUREN
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-4455
Practice Address - Country:US
Practice Address - Phone:580-237-3338
Practice Address - Fax:580-237-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK189213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK242801356Medicaid
OK4800337242OtherRAILROAD MEDICARE
OK248801356001OtherBLUE CROSS BLUE SHIELD
OKOK 189OtherSTATE LICENSURE
OK175470500OtherU.S. DEPT. OF LABOR
OK100779730AMedicaid
OK1437133436OtherPERSONAL NPI NUMBER
OK1754470500OtherWORKERS COMP.
OK243726302OtherMEDICARE GRP MEMBER PTAN
OK1194848606OtherGROUP NPI
OK10885619OtherCAQH
OK200129000AOtherMEDICAID DME
OKBS3585582OtherSTATE DEA
OK175470500OtherU.S. DEPT. OF LABOR
OK=========OtherTAX ID
OK243726302OtherMEDICARE GRP MEMBER PTAN
OKU42028Medicare UPIN
OKBS3585582OtherSTATE DEA
OK1754470500OtherWORKERS COMP.