Provider Demographics
NPI:1518946490
Name:SHELBY WOMENS CLINIC PA
Entity Type:Organization
Organization Name:SHELBY WOMENS CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MITZI
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-487-5258
Mailing Address - Street 1:110 WEST GROVER STREET
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152
Mailing Address - Country:US
Mailing Address - Phone:704-487-5259
Mailing Address - Fax:704-480-1019
Practice Address - Street 1:110 WEST GROVER STREET
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152
Practice Address - Country:US
Practice Address - Phone:704-487-5259
Practice Address - Fax:704-480-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902662Medicaid
02662OtherBCBS
02662OtherBCBS
=========OtherTAX ID