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

NPI Information

  • NPI: 1891003802
  • Provider Name: SHANE GILLIAM, M.D., P.A.
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • Other Name: FAMILY MEDICINE ASSOCIATES OF STEPHENVILLE
  • CLIA Number: 45D2161999
  • Address: 630 N GRAHAM STREET
    STEPHENVILLE, TX
    ZIP 76401
  • Phone: (254) 965-8760

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NPI Details

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
1261QP2300XClinic/CenterPrimary CareL7278TEXASYes

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: 3/30/2025

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