MEDICARE: SHANE SCOTT PARMER 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	208600000X	Surgery Physician	MD073786L	PA
2	2086S0129X	Vascular Surgery Physician	87498	SC
3	2086S0129X	Vascular Surgery Physician	22508	WV
4	2086S0129X	Vascular Surgery Physician	35.088549	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000640672	OTHER	OH	ANTHEM
2	P00799798	OTHER	OH	RRMCR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000696943	OTHER	OH	ANTHEM
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780685792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE SCOTT PARMER MD

Provider Business Mailing Address
First Line	:	PO BOX 449
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-0449
Country	:	US
Telephone Number	:	740-374-4500
Fax Number	:	740-374-5887

Provider Business Practice Location Address
First Line	:	3 RICHLAND MEDICAL PARK DR STE 330
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6862
Country	:	US
Telephone Number	:	803-434-7100
Fax Number	:	803-434-6889

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	11/04/2024

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Directions to “ SHANE SCOTT PARMER MD” Practice Location

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