Provider Demographics
NPI:1265410302
Name:SHAW'S PROSTHETICS PLUS, INC
Entity type:Organization
Organization Name:SHAW'S PROSTHETICS PLUS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, FAAOP, BOCOP
Authorized Official - Phone:270-684-7672
Mailing Address - Street 1:1019 OLD HARTFORD RD.
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303
Mailing Address - Country:US
Mailing Address - Phone:270-684-7672
Mailing Address - Fax:270-684-7094
Practice Address - Street 1:1019 OLD HARTFORD RD.
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-684-7672
Practice Address - Fax:270-684-7094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90460304Medicaid
KY1086610001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER