Provider Demographics
NPI:1679239727
Name:SHIVERS MEDICAL SERVICES LIMITED
Entity Type:Organization
Organization Name:SHIVERS MEDICAL SERVICES LIMITED
Other - Org Name:R. MARK SHIVERS SOLE MBR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / MD
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SHIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-614-8411
Mailing Address - Street 1:4347 PORTAGE ST NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7371
Mailing Address - Country:US
Mailing Address - Phone:330-614-8411
Mailing Address - Fax:330-244-8521
Practice Address - Street 1:214 WOODSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-7688
Practice Address - Country:US
Practice Address - Phone:330-614-8411
Practice Address - Fax:330-244-8521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0975995Medicaid