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NPI Code Detail

MEDICARE: SUZANNE M SHIMAITIS P.A.C.

MEDICARE: SUZANNE M SHIMAITIS P.A.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
1363A00000XPhysician Assistant085-002827IL

General Provider Information

NPI Number : 1285718874
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUZANNE M SHIMAITIS P.A.C.
Provider Business Mailing Address
First Line : 702 S CUMBERLAND ST
Second Line :
City : LEBANON
State : TN
Zip : 37087-4110
Country : US
Telephone Number : 615-444-2121
Fax Number : 615-547-6474
Provider Business Practice Location Address
First Line : 702 S CUMBERLAND ST
Second Line :
City : LEBANON
State : TN
Zip : 37087-4110
Country : US
Telephone Number : 615-444-2121
Fax Number : 615-547-6474
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 03/08/2022

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