Provider Demographics
NPI:1902041007
Name:SHELBY MEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:SHELBY MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GIDEON
Authorized Official - Middle Name:
Authorized Official - Last Name:BESSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-482-1482
Mailing Address - Street 1:711 N DEKALB ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3911
Mailing Address - Country:US
Mailing Address - Phone:704-482-1482
Mailing Address - Fax:704-480-6012
Practice Address - Street 1:711 N DEKALB ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3911
Practice Address - Country:US
Practice Address - Phone:704-482-1482
Practice Address - Fax:704-480-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC047CVOtherBCBS OF NC