Provider Demographics
NPI:1588855902
Name:SHELBYVILLE CLINIC CORP
Entity Type:Organization
Organization Name:SHELBYVILLE CLINIC CORP
Other - Org Name:JAN CREAN OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9813
Mailing Address - Street 1:841 UNION ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37162-2611
Mailing Address - Country:US
Mailing Address - Phone:931-685-5536
Mailing Address - Fax:931-685-5507
Practice Address - Street 1:841 UNION ST
Practice Address - Street 2:SUITE K
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37162-2611
Practice Address - Country:US
Practice Address - Phone:931-685-5536
Practice Address - Fax:931-685-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732391Medicare Oscar/Certification