William H Shackelford MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WILLIAM H SHACKELFORD MD

Practice address

208 S Jackson St
Cerro Gordo, IL 62501

Phone

(217) 763-5851

Fax

(217) 763-2201

NPI assigned

Sep 26, 2005

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) 763-5851

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Shackelford Clinic Other name

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
  • Arthur, IL
  • NPI 1164418067
  NPD tax ID

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1326034232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20",
            "city": "CERRO GORDO",
            "state": "IL",
            "postal_code": "618180020",
            "telephone_number": "217-763-5851",
            "fax_number": "217-763-2201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 S JACKSON ST",
            "city": "CERRO GORDO",
            "state": "IL",
            "postal_code": "62501",
            "telephone_number": "217-763-5851",
            "fax_number": "217-763-2201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM H SHACKELFORD MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-26",
        "last_updated": "2020-08-22",
        "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": "217-763-5851",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "0007423084",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036034153-2",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shackelford Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jac Stores Inc
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• Matt Rice
• John Albert Sochor, DDS
• Andrea Tirpak, N.P.

• Family Medicine Physician in Cerro Gordo, IL
• Providers in Cerro Gordo, 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 Aug 22, 2020; 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.