MEDICARE: MAJOR AFFILIATES INC. DBA SHELBYVILLE PEDIATRICS

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	173000000X	Legal Medicine

Other Identifiers

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

General Provider Information

NPI Number	:	1275628679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAJOR AFFILIATES INC. DBA SHELBYVILLE PEDIATRICS

Provider Business Mailing Address
First Line	:	30 W RAMPART ST
Second Line	:	SUITE 170
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8846
Country	:	US
Telephone Number	:	317-398-7337
Fax Number	:	317-421-0372

Provider Business Practice Location Address
First Line	:	30 W RAMPART ST
Second Line	:	SUITE 170
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8846
Country	:	US
Telephone Number	:	317-398-7337
Fax Number	:	317-421-0372

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. SHELLEY GLIDDEN
Credential	:
Telephone Number	:	317-398-7337

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	05/14/2008

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