Shane Burgess, COTA/L
Individual provider Active NPI Skilled Nursing Facility · Paris, IL
NPI 1932363736 · NPPES record last updated Jul 11, 2008
Key facts
- NPI
- 1932363736
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 057.002001 (IL)
- Practice address
- 310 S Eads Ave
Paris, IL 61944-1938 - Phone
- (217) 465-5395
- NPI assigned
- Jul 11, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057.002001 | IL | MD | Skilled Nursing Facility |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 057.002001 | IL | Yes |
Addresses
Primary practice location
310 S Eads Ave
Paris, IL 61944-1938
Mailing address
3812 Western Ave
Mattoon, IL 61938-2044
Phone (217) 273-3998
Other providers in Paris, IL
- Tabitha Boyd
- Brookstone Estates of Paris
- Judy Brown
- Leslie Michelle Brown
- Darren C Brucken
- Pamela A Burkybile
- Jenelle Calpe
- Stacey Lane Calvert
- Mykala Carpenter
- Joshua Childress
All providers in Paris, IL · Skilled Nursing Facility in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2008. 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.