Provider Demographics
NPI:1508947599
Name:SHOEHEEL MEDICAL ARTS INC
Entity Type:Organization
Organization Name:SHOEHEEL MEDICAL ARTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:910-844-5681
Mailing Address - Street 1:102 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-1262
Mailing Address - Country:US
Mailing Address - Phone:910-844-5681
Mailing Address - Fax:910-844-5650
Practice Address - Street 1:102 PINE STREET
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-1262
Practice Address - Country:US
Practice Address - Phone:910-844-5681
Practice Address - Fax:910-844-5650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343878AMedicaid
NC343878CMedicaid
NC343878AMedicaid