Healthcare Provider Details

I. General information

NPI: 1508947599
Provider Name (Legal Business Name): SHOEHEEL MEDICAL ARTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PINE STREET
MAXTON NC
28364-1262
US

IV. Provider business mailing address

102 PINE STREET
MAXTON NC
28364-1262
US

V. Phone/Fax

Practice location:
  • Phone: 910-844-5681
  • Fax: 910-844-5650
Mailing address:
  • Phone: 910-844-5681
  • Fax: 910-844-5650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. JAMES MICHAEL SULLIVAN
Title or Position: ADMINISTRATOR
Credential: PHYSICIAN ASSISTANT
Phone: 910-844-5681