MEDICARE: STEPHEN W SHEA D.O.

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	207X00000X	Orthopaedic Surgery Physician	48512-021	WI
2	207X00000X	Orthopaedic Surgery Physician	DO22320	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R179204	OTHER	OR	MEDICARE FOR RSC
4	R179202	OTHER	OR	MEDICARE FOR CHD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	14879696985	OTHER	OR	CURRY HEALTH DISTRICT
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245226935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN W SHEA D.O.

Provider Business Mailing Address
First Line	:	94220 4TH ST
Second Line	:
City	:	GOLD BEACH
State	:	OR
Zip	:	97444-7756
Country	:	US
Telephone Number	:	541-247-3000
Fax Number	:	541-247-3101

Provider Business Practice Location Address
First Line	:	500 5TH ST
Second Line	:
City	:	BROOKINGS
State	:	OR
Zip	:	97415-9702
Country	:	US
Telephone Number	:	541-412-2000
Fax Number	:	541-412-2081

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	08/18/2015

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Directions to “ STEPHEN W SHEA D.O.” Practice Location

Language	Start Address	Practice Location

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