| Victor A. Shada, D.O., P.C. | |
|
396 S Main St Crossville TN 38555-5092 | |
| (931) 484-4560 | |
| (931) 484-1480 |
| Full Name | Victor A. Shada, D.O., P.C. |
|---|---|
| Speciality | Family Medicine |
| Location | 396 S Main St, Crossville, Tennessee |
| Authorized Official Name and Position | Victor Anthony Shada (OWNER) |
| Authorized Official Contact | 9314844560 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victor A. Shada, D.O., P.C. Po Box 887 Crossville TN 38557-0887 Ph: (931) 484-4560 | Victor A. Shada, D.O., P.C. 396 S Main St Crossville TN 38555-5092 Ph: (931) 484-4560 |
| NPI Number | 1407037211 |
|---|---|
| Provider Enumeration Date | 11/20/2007 |
| Last Update Date | 07/09/2010 |
| Medicare PECOS PAC ID | 2365532553 |
|---|---|
| Medicare Enrollment ID | O20071211000792 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407037211 | NPI | - | NPPES |
| 3306875 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 1424 (Tennessee) | Primary |
| Provider Name | Victor a Shada |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851390728 PECOS PAC ID: 3476448309 Enrollment ID: I20040727000398 |
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