=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487656724
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH BETH SHUBERT MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2005
-----------------------------------------------------
Last Update Date | 01/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 AUBURN ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04103-6003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-797-4791
-----------------------------------------------------
Fax | 207-317-5390
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT PO BOX 7291
-----------------------------------------------------
City | LEWISTON
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04243-7291
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-777-8950
-----------------------------------------------------
Fax | 207-777-8800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 018045
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | A90230
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | M3461
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------