MEDICARE: DR. SHAWN P. GRIFFIN 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
1	207Q00000X	Family Medicine Physician	113444	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	400268	OTHER	MO	BLUE CROSS/BLUE SHIELD KS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2042934	OTHER	MO	AETNA
5	10001084500	OTHER	MO	COMMUNITY HEALTH PLAN
6	26D0896653	OTHER	MO	CLIA
7	24468016	OTHER	MO	BLUE CROSS/BLUE SHIELD KC

General Provider Information

NPI Number	:	1700804788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAWN P. GRIFFIN MD

Provider Business Mailing Address
First Line	:	5210 NORTH BELT HWY
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-1211
Country	:	US
Telephone Number	:	816-271-4996
Fax Number	:	816-271-4926

Provider Business Practice Location Address
First Line	:	5210 NORTH BELT HWY
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-1211
Country	:	US
Telephone Number	:	816-271-4996
Fax Number	:	816-271-4926

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	05/20/2008

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