Provider Demographics
NPI:1275628679
Name:MAJOR AFFILIATES INC. DBA SHELBYVILLE PEDIATRICS
Entity Type:Organization
Organization Name:MAJOR AFFILIATES INC. DBA SHELBYVILLE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLIDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-398-7337
Mailing Address - Street 1:30 W RAMPART ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8846
Mailing Address - Country:US
Mailing Address - Phone:317-398-7337
Mailing Address - Fax:317-421-0372
Practice Address - Street 1:30 W RAMPART ST
Practice Address - Street 2:SUITE 170
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8846
Practice Address - Country:US
Practice Address - Phone:317-398-7337
Practice Address - Fax:317-421-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200250240Medicaid
IN253400CMedicare PIN
IN200250240Medicaid
IN253400AMedicare PIN