Healthcare Provider Details

I. General information

NPI: 1679239727
Provider Name (Legal Business Name): SHIVERS MEDICAL SERVICES LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 WOODSIDE DRIVE
SALEM OH
44460-7688
US

IV. Provider business mailing address

4347 PORTAGE ST NW SUITE 102
NORTH CANTON OH
44720-7371
US

V. Phone/Fax

Practice location:
  • Phone: 330-614-8411
  • Fax: 330-244-8521
Mailing address:
  • Phone: 330-614-8411
  • Fax: 330-244-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD MARK SHIVERS
Title or Position: OWNER / MD
Credential: MD
Phone: 330-614-8411