Provider Demographics
NPI:1912170671
Name:AMR OMAR SHAWARBY INCORPORATED
Entity Type:Organization
Organization Name:AMR OMAR SHAWARBY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL CARE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SHELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN,CNOR
Authorized Official - Phone:814-948-2805
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:2611 BIGLER AVENUE
Mailing Address - City:NORTHERN CAMBRIA
Mailing Address - State:PA
Mailing Address - Zip Code:15714-0727
Mailing Address - Country:US
Mailing Address - Phone:814-948-2805
Mailing Address - Fax:814-948-2975
Practice Address - Street 1:2611 BIGLER AVENUE
Practice Address - Street 2:
Practice Address - City:NORTHERN CAMBRIA
Practice Address - State:PA
Practice Address - Zip Code:15714-0727
Practice Address - Country:US
Practice Address - Phone:814-948-2805
Practice Address - Fax:814-948-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-064306-L208600000X, 2086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016977950005Medicaid
PA0016977950005Medicaid
PA009836Medicare PIN