MEDICARE: MITCHELL C. SHIRAH M.D. P.C.

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	207Q00000X	Family Medicine Physician	9705	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC5335	OTHER	AL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265603351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL C. SHIRAH M.D. P.C.

Provider Business Mailing Address
First Line	:	59664 HIGHWAY 22
Second Line	:
City	:	ROANOKE
State	:	AL
Zip	:	36274-4438
Country	:	US
Telephone Number	:	334-863-8951
Fax Number	:	334-863-2361

Provider Business Practice Location Address
First Line	:	59664 HIGHWAY 22
Second Line	:
City	:	ROANOKE
State	:	AL
Zip	:	36274-4438
Country	:	US
Telephone Number	:	334-863-8951
Fax Number	:	334-863-2361

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. STEPHANIE LYNN ESTES
Credential	:	RN, BSN
Telephone Number	:	334-863-8951

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	09/09/2013

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Directions to “MITCHELL C. SHIRAH M.D. P.C. ” Practice Location

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