Provider Demographics
NPI:1336273218
Name:RANDY R. SHEMER D.O. L.L.C.
Entity Type:Organization
Organization Name:RANDY R. SHEMER D.O. L.L.C.
Other - Org Name:RANDY R. SHEMER D.O. L.L.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SHEMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-770-0771
Mailing Address - Street 1:3419 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3131
Mailing Address - Country:US
Mailing Address - Phone:724-770-0771
Mailing Address - Fax:724-770-0607
Practice Address - Street 1:3419 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3131
Practice Address - Country:US
Practice Address - Phone:724-770-0771
Practice Address - Fax:724-770-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-008808L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015442300007Medicaid
PA0015442300007Medicaid
PA792256Medicare ID - Type Unspecified