William H Shackelford MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WILLIAM H SHACKELFORD MD

Practice address

525 N Vine St
Arthur, IL 61911-1137

Phone

(217) 543-3628

Fax

(217) 543-2921

NPI assigned

Sep 26, 2005

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

William H Shackelford, MD

Title

Owner

Phone

(217) 543-3628

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Shackelford Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• William H Shackelford MD

  • Family Medicine Physician
  • Cerro Gordo, IL
  • NPI 1326034232
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1164418067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 N VINE ST",
            "city": "ARTHUR",
            "state": "IL",
            "postal_code": "619111137",
            "telephone_number": "217-543-3628",
            "fax_number": "217-543-2921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N VINE ST",
            "city": "ARTHUR",
            "state": "IL",
            "postal_code": "619111137",
            "telephone_number": "217-543-3628",
            "fax_number": "217-543-2921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM H SHACKELFORD MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-26",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SHACKELFORD",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-543-3628",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "0007415015",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036034153-1",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Mark Schrock, LMT
• Jessica Smith, LMT
• Southern Illinois Healthcare Foundation Inc (SIHF Healthcare)
• Shawna L Storm, FNP-C
• Jameia C Tyler, CF, MA
• Willow Tree Wellness Center LLC
• Dolores Josephine Wilson, APRN, FNP-C
• James E Winfield, DMD
• Kimberly Drew Wingler, LMT

• Family Medicine Physician in Arthur, IL
• Providers in Arthur, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.