Provider Demographics
NPI:1982899795
Name:SHORS, HEIDI CORYELL (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:CORYELL
Last Name:SHORS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HEIDI
Other - Middle Name:CORYELL
Other - Last Name:AMBROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:350 HERITAGE WAY STE 1200
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3160
Mailing Address - Country:US
Mailing Address - Phone:406-752-6784
Mailing Address - Fax:406-756-4111
Practice Address - Street 1:350 HERITAGE WAY STE 1200
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3160
Practice Address - Country:US
Practice Address - Phone:406-752-6784
Practice Address - Fax:406-756-4111
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048758207XS0106X
MT49525207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8289SHOtherBLUE SHIELD#
WA0039580OtherLABOR AND INDUSTRIES#
WA8496218Medicaid
WAP00417132OtherRAILROAD MC#
WA8874971Medicare PIN
WA8868265Medicare PIN
WAP00417132OtherRAILROAD MC#