Healthcare Provider Details

I. General information

NPI: 1982928701
Provider Name (Legal Business Name): W. EDWARD SHUTTLEWORTH PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 MEDICAL CENTER DR STE A
POWDERLY KY
42367-5463
US

IV. Provider business mailing address

1008 MEDICAL CENTER DR STE A
POWDERLY KY
42367-5463
US

V. Phone/Fax

Practice location:
  • Phone: 270-338-9653
  • Fax: 270-338-9656
Mailing address:
  • Phone: 270-338-9653
  • Fax: 270-338-9656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM EDWARD SHUTTLEWORTH
Title or Position: OWNER
Credential: MD
Phone: 270-338-9653