Provider Demographics
NPI:1376028019
Name:SHINER MEDICAL LLP
Entity type:Organization
Organization Name:SHINER MEDICAL LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-594-3824
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:SHINER
Mailing Address - State:TX
Mailing Address - Zip Code:77984-0965
Mailing Address - Country:US
Mailing Address - Phone:361-594-3824
Mailing Address - Fax:361-594-3854
Practice Address - Street 1:124 E WOLTERS
Practice Address - Street 2:
Practice Address - City:SHINER
Practice Address - State:TX
Practice Address - Zip Code:77984
Practice Address - Country:US
Practice Address - Phone:361-594-3824
Practice Address - Fax:361-594-3854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135624802Medicaid
TX379626001Medicaid
TX037427402Medicaid
TX138955307Medicaid
TX138955301Medicaid