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General NPI Number Information
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NPI Number | 1528696473
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Entity Type | Organization
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Legal Business Name | SHIRES REHAB LLC
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 180 MOUNT PELIA RD
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City | MARTIN
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State | TN
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Zip | 38237-3812
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Country | US
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Telephone | 731-660-2665
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11942
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City | JACKSON
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State | TN
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Zip | 38308-0132
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | JAY SHIRES
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Credential | MD
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Telephone | 731-660-2665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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