Active NPI
Shirley Ann Shaw
- Non-emergency Medical Transport (VAN)
- Homewood, IL
National Provider Identifier
1003052655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Non-emergency Medical Transport (VAN)
- License
- MC6805
- Practice address
- 17851 Gladville Ave
Homewood, IL 60430-1836 - Phone
- (773) 386-5355
- Fax
- (708) 991-7835
- NPI assigned
- Jan 4, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Non-emergency Medical Transport (VAN) | 343900000X | MC6805 | IL | Primary |
Addresses
Primary practice location
17851 Gladville Ave
Homewood, IL 60430-1836
Mailing address
17851 Gladville Ave
Homewood, IL 60430-1836
Phone (773) 386-5355
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MC6805 | IL | MD | Non-emergency Medical Transport (VAN) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231027200000",
"number": "1003052655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17851 GLADVILLE AVE",
"city": "HOMEWOOD",
"state": "IL",
"postal_code": "604301836",
"telephone_number": "773-386-5355",
"fax_number": "708-991-7835"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17851 GLADVILLE AVE",
"city": "HOMEWOOD",
"state": "IL",
"postal_code": "604301836",
"telephone_number": "773-386-5355",
"fax_number": "708-991-7835"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "SHIRLEY",
"middle_name": "ANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-01-04",
"last_updated": "2009-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "343900000X",
"taxonomy_group": "",
"desc": "Non-emergency Medical Transport (VAN)",
"state": "IL",
"license": "MC6805",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Homewood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.