Provider Demographics
NPI:1609964881
Name:SHAWN MCCANN MD, LLC
Entity Type:Organization
Organization Name:SHAWN MCCANN MD, LLC
Other - Org Name:SHAWN MCCANN MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:ELLINGTON
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-240-9503
Mailing Address - Street 1:424 N WASHINGTON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2426
Mailing Address - Country:US
Mailing Address - Phone:318-240-9503
Mailing Address - Fax:318-240-9504
Practice Address - Street 1:424 N WASHINGTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2426
Practice Address - Country:US
Practice Address - Phone:318-240-9503
Practice Address - Fax:318-240-9504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022900261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1582816Medicaid
LA5CV20Medicare PIN
LAI33517Medicare UPIN