Organization
CAROL SHACKLETON, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL SHACKLETON M.D. (OWNER)
(308) 537-7131
Entity
Organization
Contact information
Practice address
918 20TH STREET, GOTHENBURG, NE 69138-1237
(308) 537-7131
(308) 537-7310
Mailing address
918 20TH STREET, GOTHENBURG, NE 69138-1237
(308) 537-7131
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
16620
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03042
BC/BS
NE
01
—
099905
MEDICARE GROUP
NE
05
—
100253852-00
—
NE
01
—
11595205
CAQH
NE
01
—
280121
MEDICARE PTAN
—
01
—
6366
MIDLANDS CHOICE
NE
Enumeration date
11/01/2006
Last updated
02/09/2012
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