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General NPI Number Information
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NPI Number | 1912170671
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Entity Type | Organization
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Legal Business Name | AMR OMAR SHAWARBY INCORPORATED
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 2611 BIGLER AVENUE
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City | NORTHERN CAMBRIA
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State | PA
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Zip | 15714-0727
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Country | US
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Telephone | 814-948-2805
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Fax | 814-948-2975
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Provider Business Mailing Address
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Address Line | PO BOX 727 2611 BIGLER AVENUE
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City | NORTHERN CAMBRIA
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State | PA
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Zip | 15714-0727
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Country | US
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Telephone | 814-948-2805
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Fax | 814-948-2975
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Authorized Official
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Title or Position | SURGICAL CARE COORDINATOR
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Name | MS. LISA JEAN SHELL
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Credential | RN,CNOR
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Telephone | 814-948-2805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MD-064306-L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | MD-064306-L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD-064306-L
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License Number State | PA
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