Victor a. Shada, D.O., P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1424 Issued in TN

Legal business name

VICTOR A. SHADA, D.O., P.C.

Practice address

396 S Main St
Crossville, TN 38555-5092

Phone

(931) 484-4560

Fax

(931) 484-1480

NPI assigned

Nov 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Victor Anthony Shada, D.O.NPI 1851390728

Title

Owner

Phone

(931) 484-4560

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Victor A Shada, D.O.

  • Family Medicine Physician
  • Crossville, TN
  • NPI 1851390728
  Medicare reassignment Care Compare group NPD Authorized official
• Hanna Marie King, FNP-C

  • Family Nurse Practitioner
  • Crossville, TN
  • NPI 1164375762

  Family Medicine

  Care Compare group NPD
• Jill K Denney, PA-C

  • Medical Physician Assistant
  • Crossville, TN
  • NPI 1851441679
  NPD (past)
• Johnny Wayne Presley, PAC

  • Medical Physician Assistant
  • Jamestown, TN
  • NPI 1427069749
  NPD (past)

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

{
    "created_epoch": "1195516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278633600000",
    "number": "1407037211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 887",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385570887",
            "telephone_number": "931-484-4560",
            "fax_number": "931-484-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "396 S MAIN ST",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385555092",
            "telephone_number": "931-484-4560",
            "fax_number": "931-484-1480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTOR A. SHADA, D.O., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-20",
        "last_updated": "2010-07-09",
        "status": "A",
        "authorized_official_last_name": "SHADA",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-484-4560",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "1424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3306875",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ronald James Varcak, D.O.
• Mallory Varner, MS, CCC-SLP
• Karen Varney
• Ryan Wagner Varnum
• Vascular Wellness Center Inc
• Vianney Epina Villaruz, MD
• Adrian Vinas
• Jack Monroe Visca
• Kimberly Dawn Wagner, FNP-BC
• Cindy Wakham, D.PH.

• Family Medicine Physician in Crossville, TN
• Providers in Crossville, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.