Healthcare Provider Details

I. General information

NPI: 1043334857
Provider Name (Legal Business Name): SHAWMED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 W. BROADWAY
EUGENE OR
97401
US

IV. Provider business mailing address

198 W. BROADWAY
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-4276
  • Fax: 541-342-4299
Mailing address:
  • Phone: 541-342-4276
  • Fax: 541-342-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number370450-2
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier174714
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MS. JANET CARLSON
Title or Position: PRESIDENT
Credential:
Phone: 541-342-4276