CAROL SHACKLETON, M.D., P.C. (NPI# 1194803619) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194803619 |
| Entity Type | Organization |
| Organization Name | CAROL SHACKLETON, M.D., P.C. |
| Practice Address |
918 20th Street Gothenburg NE 69138-1237 |
| Practice Telephone | 3085377131 |
| Practice Fax Number | 3085377310 |
| Mailing Telephone | 3085377131 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2012-02-09 |
| Authorized Official Name | CAROL SHACKLETON (OWNER) |
| Authorized Official Telephone | 3085377131 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 16620 | NE | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | MEDICARE GROUP | 099905 | 01 |
| NE | CAQH | 11595205 | 01 |
| NE | BC/BS | 03042 | 01 |
| NE | MIDLANDS CHOICE | 6366 | 01 |
| NE | 100253852-00 | 05 | |
| MEDICARE PTAN | 280121 | 01 |
| Street Address |
918 20TH STREET |
| City | GOTHENBURG |
| State | NE |
| Zip Code | 69138-1237 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750352480 | Amy S Mahar | Physician Assistant | 918 20th Street, Gothenburg, NE 69138-1237 | 2006-01-31 |
| 1639401508 | Gothenburg Family Practice Rural Health Clinic LLC | Clinic/Center | 918 20th Street, Gothenburg, NE 69138-1237 | 2010-02-03 |
| 1043413511 | David Hult, M.d., P.C. | Family Medicine | 918 20th Street, Gothenburg, NE 69138-1237 | 2007-06-11 |
| 1689736019 | Aaron I Salomon | Physician Assistant | 918 20th Street, Gothenburg, NE 69138-1237 | 2006-12-14 |
| 1932201803 | Family and Sport Medicine, PC | Family Medicine | 918 20th Street, Gothenburg, NE 69138-1237 | 2006-09-02 |
| 1154345973 | Gerald E Matzke Jr. | Emergency Medicine | 918 20th Street, Gothenburg, NE 69138-1237 | 2006-07-26 |
| 1629004759 | Carol L Shackleton | Family Medicine | 918 20th Street, Gothenburg, NE 69138-1237 | 2006-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215235023 | Gottenburg Senior Living, LLC | Assisted Living Facility | 110 20th Street, Gothenburg, NE 69138 | 2011-03-02 |
| 1215108758 | Shopko Stores Operating Co LLC | Pharmacy | 718 4th Street, Gothenburg, NE 69138 | 2008-03-12 |
| 1013047810 | Randal E Strohmyer | Dentist | 513 10th Street, Gothenburg, NE 69138 | 2007-03-07 |
| 1225177652 | Brenda Hiebner | Counselor | 815 Lake Ave, Gothenburg, NE 69138 | 2007-02-05 |
| 1790887917 | Royce Lydell Hiebner | Chiropractor | 417 9th St, Gothenburg, NE 69138 | 2006-09-01 |
| 1649652306 | Kayla S Knauss | Family Medicine | 918 20th St, Gothenburg, NE 69138 | 2015-06-18 |
| 1427499854 | Wendy Hunt Most | Counselor | 41190 Road 768, Gothenburg, NE 69138-1189 | 2013-07-14 |
| 1588022180 | Life Transitions LLC | Counselor | 41190 Road 768, Gothenburg, NE 69138-1189 | 2016-02-10 |
| 1871566695 | Garret T Shaw | Family Medicine | 918 20th St, Gothenburg, NE 69138-1237 | 2006-02-10 |
| 1962059766 | Gothenburg Memorial Hospital | Family Medicine | 918 20th St, Gothenburg, NE 69138-1237 | 2019-08-26 |
| Find all providers in zip 69138 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194803353 | Christopher P Costa Md PC | Family Medicine | 514 9th Street, Gothenburg, NE 69138-1917 | 2006-11-02 |
| 1871566695 | Garret T Shaw | Family Medicine | 918 20th St, Gothenburg, NE 69138-1237 | 2006-02-10 |
| 1962059766 | Gothenburg Memorial Hospital | Family Medicine | 918 20th St, Gothenburg, NE 69138-1237 | 2019-08-26 |
| 1649652306 | Kayla S Knauss | Family Medicine | 918 20th St, Gothenburg, NE 69138 | 2015-06-18 |
| 1043413511 | David Hult, M.d., P.C. | Family Medicine | 918 20th Street, Gothenburg, NE 69138-1237 | 2007-06-11 |
| 1629004759 | Carol L Shackleton | Family Medicine | 918 20th Street, Gothenburg, NE 69138-1237 | 2006-06-23 |
| 1801833660 | Craig David Bartruff | Family Medicine | 619 10th St, Gothenburg, NE 69138-2063 | 2006-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740898907 | Physician Management Services of Nebraska, LLC | Family Medicine | 2222 S 16th St Ste 435, Lincoln, NE 68502-3793 | 2020-07-14 |
| 1891313706 | Me Urgent Care Nebraska, Inc | Family Medicine | 28800 Ida Cir, Valley, NE 68064-8017 | 2020-07-07 |
| 1356968408 | Joanna Sarah Jacob | Family Medicine | 3601 Jones St Apt 350, Omaha, NE 68105-1526 | 2020-07-05 |
| 1255958443 | Sreelakshmi Surendran Pillai | Family Medicine | 7710 Mercy Road, Suite 202-cu, Department of Family Mediicine, Omaha, NE 68124-2353 | 2020-07-03 |
| 1891312443 | Stefany Malanka | Family Medicine | 7710 Mercy Rd, Suite 202, Cu Department of Family Medicine, Omaha, NE 68124 | 2020-06-30 |
| 1831714062 | Allison Alise Bird | Family Medicine | Family Practice 983075 Nebraska Medical Center, Omaha, NE 68198-3075 | 2020-06-12 |
| 1508486416 | Bluestem Health | Family Medicine | 1500 S 48th St Ste 412, Lincoln, NE 68506-1278 | 2020-04-21 |
| 1285267526 | Banyan Medical Systems | Family Medicine | 8656 F St, Plaza F, Omaha, NE 68127-1639 | 2020-02-14 |
| 1669021796 | Melissa Prickett | Family Medicine | 14000 Hospital Road, Boys Town, NE 68010 | 2019-09-11 |
| 1144888579 | Lexington Regional Health Center | Family Medicine | 1101 Buffalo Bnd Ste A, Lexington, NE 68850-1528 | 2019-05-31 |
| Find all providers with the same taxonomy | ||||
| City | GOTHENBURG |
| Zip Code | 69138 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.