Provider Demographics
NPI:1619993250
Name:JOEL SHEBOWICH MD PC
Entity Type:Organization
Organization Name:JOEL SHEBOWICH MD PC
Other - Org Name:SMOKY HILL FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEBOWICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-680-9150
Mailing Address - Street 1:13111 E BRIARWOOD AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3846
Mailing Address - Country:US
Mailing Address - Phone:303-680-9150
Mailing Address - Fax:303-680-9149
Practice Address - Street 1:13111 E BRIARWOOD AVE STE 215
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3846
Practice Address - Country:US
Practice Address - Phone:303-680-9150
Practice Address - Fax:303-680-9149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC394018Medicare PIN
COC478378Medicare UPIN
COH28638Medicare UPIN
COC471158Medicare PIN
COC471148Medicare UPIN
COC478378Medicare PIN
COC43054Medicare UPIN
COC471148Medicare PIN