Provider Demographics
NPI:1447422688
Name:HUGH SHIELS MD PS
Entity Type:Organization
Organization Name:HUGH SHIELS MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-837-7202
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-0836
Mailing Address - Country:US
Mailing Address - Phone:509-837-7202
Mailing Address - Fax:509-837-2794
Practice Address - Street 1:1413 E EDISON AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-1622
Practice Address - Country:US
Practice Address - Phone:509-837-7202
Practice Address - Fax:509-837-2794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015096207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA75025OtherLABOR AND INDUSTRIES
WAA06606Medicare UPIN