| Carol Shackleton, M.d., P.c. | |
|
918 20th Street Gothenburg NE 69138-1237 | |
| (308) 537-7131 | |
| (308) 537-7310 |
| Full Name | Carol Shackleton, M.d., P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 918 20th Street, Gothenburg, Nebraska |
| Authorized Official Name and Position | Carol Shackleton (OWNER) |
| Authorized Official Contact | 3085377131 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Carol Shackleton, M.d., P.c. 918 20th Street Gothenburg NE 69138-1237 Ph: (308) 537-7131 | Carol Shackleton, M.d., P.c. 918 20th Street Gothenburg NE 69138-1237 Ph: (308) 537-7131 |
| NPI Number | 1194803619 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 02/09/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194803619 | NPI | - | NPPES |
| 11595205 | Other | NE | CAQH |
| 280121 | Other | MEDICARE PTAN | |
| 03042 | Other | NE | BC/BS |
| 099905 | Other | NE | MEDICARE GROUP |
| 6366 | Other | NE | MIDLANDS CHOICE |
| 100253852-00 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 16620 (Nebraska) | Primary |
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› Verified 2 days ago
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