SHAW FAMILY MEDICAL, LLC (NPI# 1750642633) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750642633 |
| Entity Type | Organization |
| Organization Name | SHAW FAMILY MEDICAL, LLC |
| Other Organization Name | SHAW FAMILY MEDICAL |
| Practice Address |
112 W Peeler Ave Shaw MS 38773-8710 |
| Mailing Address |
Po Box 299 Shaw MS 38773-0299 |
| Practice Telephone | 6627543301 |
| Practice Fax Number | 6627543304 |
| Mailing Telephone | 6627543301 |
| Mailing Fax Number | 6626543304 |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2017-02-22 |
| Authorized Official Name | NORA GOUGH-DAVIS (PARTNER) |
| Authorized Official Telephone | 6627543301 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Shaw Family Medical | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043665532 | Shaw Family Medical, LLC | Nurse Practitioner | 189 N Main St, Drew, MS 38737-3146 | 2016-05-03 |
| Street Address |
112 W PEELER AVE |
| City | SHAW |
| State | MS |
| Zip Code | 38773-8710 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740410661 | Nora Cecelia Gough-davis | Nurse Practitioner | 112 W Peeler Ave, Shaw, MS 38773-8710 | 2009-07-27 |
| 1538774310 | Tiffany Sherell Newell | Nurse Practitioner | 112 W Peeler Ave, Shaw, MS 38773-8710 | 2020-09-09 |
| 1700417961 | Vanessa Haywood | Nurse Practitioner | 112 W Peeler Ave, Shaw, MS 38773-8710 | 2020-01-27 |
| 1609416544 | Regina Jonelle Evans | Nurse Practitioner | 112 W Peeler Ave, Shaw, MS 38773-8710 | 2020-01-08 |
| 1518428283 | Willie Mary Bolden | Nurse Practitioner | 112 W Peeler Ave, Shaw, MS 38773-8710 | 2019-03-26 |
| 1912480328 | Clifton Dewayne Reed | Nurse Practitioner | 112 W Peeler Ave, Shaw, MS 38773-8710 | 2018-09-11 |
| 1023507456 | Teresa Wilson | Nurse Practitioner | 112 W Peeler Ave, Shaw, MS 38773-8710 | 2018-05-01 |
| 1144748898 | Cassandra Latasha Shepard | Nurse Practitioner | 112 W Peeler Ave, Shaw, MS 38773-8710 | 2017-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851884266 | Making Moves In The Delta | Family Medicine | 112 East Peeler Ave, Shaw, MS 38773 | 2018-06-11 |
| 1942616446 | Victoria Curry | Clinic/Center | 221 Bayou Street, Shaw, MS 38773 | 2014-07-03 |
| 1053751529 | Preservers of Life Hospice | Hospice Care, Community Based | 210 A Hwy 61 South, Shaw, MS 38773 | 2013-06-28 |
| 1629124516 | Ronnie Lane Poe | Pharmacist | 118 E Peeler Ave, Shaw, MS 38773 | 2007-01-25 |
| 1659471894 | Shaw Community Care Clinic | Clinic/Center | 112 Peeler Ave, Shaw, MS 38773 | 2006-09-25 |
| 1194854208 | Shaw Community Care Clinic | Family Medicine | 112 Peeler Ave, Shaw, MS 38773 | 2007-03-05 |
| 1255768362 | Joseph Glenn Peeler Jr. | Family Medicine | 311 Dean Blvd., Shaw, MS 38773-0470 | 2013-10-03 |
| 1669018008 | Maximum Care After Hours Clinic, LLC | Clinic/Center | 212 Highway 61, Shaw, MS 38773-3877 | 2019-11-20 |
| 1982218566 | Naala Latrice Davis | Nurse Practitioner | 415 Highway 61, Shaw, MS 38773-9425 | 2020-09-01 |
| 1174744932 | Bradley Alan Cooper | Occupational Therapist | 12 Carmelita Cv, Shaw, MS 38773-9619 | 2007-05-01 |
| Find all providers in zip 38773 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669018008 | Maximum Care After Hours Clinic, LLC | Clinic/Center | 212 Highway 61, Shaw, MS 38773-3877 | 2019-11-20 |
| 1659471894 | Shaw Community Care Clinic | Clinic/Center | 112 Peeler Ave, Shaw, MS 38773 | 2006-09-25 |
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| 1972150084 | Wound Management Specialists, LLC | Clinic/Center | 1190 N State St Ste 2a, Jackson, MS 39202-2413 | 2019-08-22 |
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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.