Provider Demographics
NPI:1265603351
Name:MITCHELL C. SHIRAH M.D. P.C.
Entity type:Organization
Organization Name:MITCHELL C. SHIRAH M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:334-863-8951
Mailing Address - Street 1:59664 HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:AL
Mailing Address - Zip Code:36274-4438
Mailing Address - Country:US
Mailing Address - Phone:334-863-8951
Mailing Address - Fax:334-863-2361
Practice Address - Street 1:59664 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:AL
Practice Address - Zip Code:36274-4438
Practice Address - Country:US
Practice Address - Phone:334-863-8951
Practice Address - Fax:334-863-2361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDC5335OtherRAILROAD MEDICARE
AL5299921880Medicaid
ALDC5335OtherRAILROAD MEDICARE