Carol Shackleton, M.D., P.C.
Organization Active NPI Family Medicine Physician · Gothenburg, NE
NPI 1194803619 · NPPES record last updated Feb 9, 2012
Key facts
- NPI
- 1194803619
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 16620 (NE)
- Legal business name
- CAROL SHACKLETON, M.D., P.C.
- Practice address
- 918 20TH Street
Gothenburg, NE 69138-1237 - Phone
- (308) 537-7131
- Fax
- (308) 537-7310
- NPI assigned
- Nov 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Carol Shackleton, M.D.
- Title
- Owner
- Phone
- (308) 537-7131
Practitioners 1
-
David D Hult, M.D.
National Provider Directory
Locations
902 20TH St
Gothenburg, NE 69138
Phone (308) 537-7131
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 16620 | NE | Yes |
Addresses
Primary practice location
918 20TH Street
Gothenburg, NE 69138-1237
Mailing address
918 20TH Street
Gothenburg, NE 69138-1237
Phone (308) 537-7131
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 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 |
Other providers in Gothenburg, NE
- Terese Ann Bevard
- Mary Lou Block
- Melissa Anne Brill
- Hunter Brimm
- Sue Britt
- Christopher P Costa MD PC
- City of Gothenburg
- Blaine Michael Cornelius
- Craig D Bartruff M.D., P.C.
- Craig D Bartruff, M.D., P.C.
All providers in Gothenburg, NE · Family Medicine Physician in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.