Provider Demographics
NPI:1205895141
Name:SHAW ANESTHESIA SERVICES, PA
Entity type:Organization
Organization Name:SHAW ANESTHESIA SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:870-523-9153
Mailing Address - Street 1:PO BOX 1266
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-1266
Mailing Address - Country:US
Mailing Address - Phone:870-523-9153
Mailing Address - Fax:870-523-9153
Practice Address - Street 1:1205 MCLAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3533
Practice Address - Country:US
Practice Address - Phone:870-523-9153
Practice Address - Fax:870-523-9153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F170Medicare ID - Type UnspecifiedANESTHESIA GRP