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NPI Code Detail

MEDICARE: JAMES W SHINE MD

MEDICARE: JAMES W SHINE MD
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
1207Q00000XFamily Medicine PhysicianMD28372TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3TN0167OTHERTNJOHN DEERE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
54062642OTHERTNBCBS

General Provider Information

NPI Number : 1194781724
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES W SHINE MD
Provider Business Mailing Address
First Line : 1901 S SHADY ST
Second Line :
City : MOUNTAIN CITY
State : TN
Zip : 37683-2021
Country : US
Telephone Number : 423-727-1103
Fax Number : 423-727-1140
Provider Business Practice Location Address
First Line : 1901 S SHADY ST
Second Line :
City : MOUNTAIN CITY
State : TN
Zip : 37683-2021
Country : US
Telephone Number : 423-727-1103
Fax Number : 423-727-1140
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2006
Last Update Date : 02/23/2017

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