MEDICARE: CN SHAW METRO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center
2	282NC2000X	Children's Hospital

General Provider Information

NPI Number	:	1073470001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CN SHAW METRO

Provider Business Mailing Address
First Line	:	111 MICHIGAN AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 S ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20001-5196
Country	:	US
Telephone Number	:	202-476-2123
Fax Number	:

Authorized Official
Title or Position	:	VP PAYOR FINANCIAL RELATIONS
Name	:	PHILLICIA NELSON
Credential	:
Telephone Number	:	301-572-6281

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/12/2026

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Directions to “CN SHAW METRO ” Practice Location

Language	Start Address	Practice Location

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