Anderson, Shane Keith

Anderson, Shane Keith is an sole proprietor health care provider with primary practice located at 220 Bannock St , Malad City ID 83252-1256. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Anderson, Shane Keith can be contacted via phone (208) 766-2600.

Contact Information

Primary practice address
220 Bannock St Malad City ID 83252-1256
Phone: (208) 766-2600
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 2004001424 Missouri
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 11818 Montana

Profile Details

NPI number 1841289659
LBN Legal business name Anderson, Shane Keith
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 14th, 2005
Last updated May 24th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841289659 NPPES
Missouri Other 000092769 PROVIDER NUMBER

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