MEDICARE: SHAW HEALTH LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1912778770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAW HEALTH LLC

Provider Business Mailing Address
First Line	:	1034 W SPUR DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-6369
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1034 W SPUR DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-6369
Country	:	US
Telephone Number	:	602-509-2863
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS SHAW
Credential	:	PHARMD
Telephone Number	:	602-509-2863

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	01/11/2024

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