Provider Demographics
NPI:1851288286
Name:SHP PROVIDER NETWORK, LLC
Entity type:Organization
Organization Name:SHP PROVIDER NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, MANAGED CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-407-0213
Mailing Address - Street 1:PO BOX 60969
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31420-0969
Mailing Address - Country:US
Mailing Address - Phone:912-691-5711
Mailing Address - Fax:
Practice Address - Street 1:7505 WATERS AVE STE F9
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3822
Practice Address - Country:US
Practice Address - Phone:912-691-5711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No282N00000XHospitalsGeneral Acute Care Hospital