SHANE GILLIAM M.D. P.A. NPI 1891003802

NPI Information

NPI: 1891003802
Provider Name: SHANE GILLIAM, M.D., P.A.

Other Name: FAMILY MEDICINE ASSOCIATES OF STEPHENVILLE

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 45D2161999

Address:
630 N GRAHAM STREET
STEPHENVILLE, TX
ZIP 76401
Phone: (254) 965-8760
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SHANE GILLIAM, M.D., P.A. is a primary care clinic center in Stephenville, TX. SHANE GILLIAM, M.D., P.A. NPI is 1891003802. The provider is registered as an organization entity type.
The provider Other Name Is Family Medicine Associates Of Stephenville.

The provider's business location address is:

630 N GRAHAM STREET
STEPHENVILLE, TX
ZIP 76401-552
Phone: (254) 965-8760
Fax: (254) 965-8766

The provider's authorized official is Leslie Shane Gilliam .
The authorized official title is Physician/owner and has the following contact phone number (254) 965-8760.

The CLIA number assigned to this NPI record is 45D2161999 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/24/2010 and was last updated on 9/24/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	L7278	TEXAS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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