SHANE CHARLES WILSON (NPI# 1477808467) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477808467 |
| Entity Type | Individual |
| Full Name | SHANE CHARLES WILSON |
| Credential | DO |
| Practice Address |
450 E Sigler Ave Ste A Memphis MO 63555-1726 |
| Practice Telephone | 6604652828 |
| Practice Fax Number | 6604652956 |
| Mailing Telephone | 6604652828 |
| Mailing Fax Number | 6604652956 |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2015-10-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 2014026613 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1477808467 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669952966 | Shane Wilson | Non-emergency Medical Transport (VAN) | 1522 S Tyler St, Little Rock, AR 72204 | 2018-08-16 |
| 1982009569 | Shane Michael Wilson | Chiropractor | 938 Wrens Roost Cir, 2, Memphis, TN 38119-0510 | 2014-10-25 |
| 1063742138 | Shane Ray Wilson | Counselor | 2820 Weymouth Way, Norman, OK 73071-7269 | 2010-01-12 |
| 1902440035 | Shane Marcus Wilson | Physical Therapy Assistant | 10600 Mastin St, Overland Park, KS 66212-5723 | 2019-11-01 |
| 1437624236 | Shane David Wilson | Nurse Practitioner | 1249 15th St Ste 4000, Huntington, WV 25701-3663 | 2018-10-08 |
| 1245548239 | Shane Wilson | Rehabilitation Practitioner | 741 Rancho Via Dr, Sparks, NV 89434-4051 | 2010-09-23 |
| 1336314392 | Shane Wilson | Counselor | 1470 W Herndon Ave, Suite 300, Fresno, CA 93711-0552 | 2008-04-29 |
| Street Address |
450 E SIGLER AVE STE A |
| City | MEMPHIS |
| State | MO |
| Zip Code | 63555-1726 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205844982 | Scotland County Memorial Hospital | Family Medicine | 450 E Sigler Ave, Suite A, Memphis, MO 63555-1726 | 2006-08-04 |
| 1235761826 | Marissa Ann Burgess | Physician Assistant | 450 E Sigler Ave, Memphis, MO 63555-1726 | 2020-02-11 |
| 1316486293 | Teresa Marie Kirchner | Nurse Practitioner | 450 E Sigler Ave, Ste A, Memphis, MO 63555-1726 | 2017-02-13 |
| 1518404847 | Scotland County Community Health Development Services, Inc. | Pharmacy | 450 E Sigler Ave, Suite A-2, Memphis, MO 63555-1726 | 2017-01-24 |
| 1619327111 | Haley Rae Shrum | Nurse Practitioner | 450 E Sigler Ave, Memphis, MO 63555-1726 | 2016-06-15 |
| 1437526258 | Jessica Christen | Nurse Practitioner | 450 E Sigler Ave, Ste A, Memphis, MO 63555-1726 | 2015-08-27 |
| 1801271788 | Sonya See | Nurse Practitioner | 450 E Sigler Ave, Ste A, Memphis, MO 63555-1726 | 2015-07-21 |
| 1962818468 | Jenna Williams | Nurse Practitioner | 450 E Sigler Ave, Ste A, Memphis, MO 63555-1726 | 2014-07-03 |
| 1841617180 | Jennifer Mcminn | Physical Therapy Assistant | 450 E Sigler Ave, Memphis, MO 63555-1726 | 2014-03-25 |
| 1881011468 | Meagan Weber | Specialist | 450 E Sigler Ave, Scotland County Hospital, Memphis, MO 63555-1726 | 2014-03-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548433485 | Pkanesthesia, Inc | Nurse Anesthetist, Certified Registered | Rt 1 Box 53, Memphis, MO 63555 | 2008-04-11 |
| 1235284167 | Darrell Lynn Monroe | Chiropractor | 107 East Monroe, Memphis, MO 63555 | 2007-01-23 |
| 1952496002 | Jeanne Kay Camden | Chiropractor | 321 North Clay, Hwy 15 North, Memphis, MO 63555 | 2006-10-04 |
| 1639190069 | Randall Tobler | Obstetrics & Gynecology | Sigler Ave, R1, Memphis, MO 63555 | 2006-07-21 |
| 1043788250 | Scotland County Pharmacy Inc | Pharmacy | 445 E Grand Ave, Memphis, MO 63555 | 2018-11-06 |
| 1093894206 | Marilyn Lee Day | Nurse Practitioner | Sigler Ave, Memphis Medical, Memphis, MO 63555 | 2006-11-06 |
| 1730293705 | Robert Wayne Jackson | Internal Medicine | Sigler Ave, Memphis, MO 63555 | 2006-08-18 |
| 1306139027 | Nicholas R Rhodes | Massage Therapist | 429 W Madison St, Memphis, MO 63555-1054 | 2011-05-27 |
| 1275709610 | Harlo Lee Donelson | Dentist | 125 S Main, Memphis, MO 63555-1423 | 2008-05-06 |
| 1801038948 | Lisa Marie Peterson | Social Worker | 215 S Main St, Memphis, MO 63555-1425 | 2009-04-06 |
| Find all providers in zip 63555 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427546415 | Christopher Nelson | Internal Medicine | 5100 Poplar Ave Ste 512, Memphis, TN 38137-0500 | 2018-04-25 |
| 1356797898 | Shwetapadma Sahu | Internal Medicine | 109 N Main St Apt 811, Memphis, TN 38103-5019 | 2016-05-13 |
| 1780030619 | Lamia Aljundi | Internal Medicine | 956 Court Avenue Suite H316b, Memphis, TN 38163-2148 | 2016-05-10 |
| 1437513439 | Highland Medical Corp | Internal Medicine | 3445 Poplar Ave Ste 13, Memphis, TN 38111-4667 | 2016-04-06 |
| 1760845994 | Anthony Selase Sallar | Internal Medicine | 920 Madison Ave Ste 300a, Memphis, TN 38103-3472 | 2016-04-04 |
| 1306218235 | Amp Medical Management, LLC | Internal Medicine | 1102 Brookfield Rd, Ste 102, Memphis, TN 38119-3826 | 2015-10-30 |
| 1245636596 | Jiten P Kothadia | Internal Medicine | 1265 Union Avenue 4 Shorb Tower, Memphis, TN 38104-4418 | 2014-11-14 |
| 1841614252 | Saurav Acharya | Internal Medicine | 956 Court Avenue G326 Coleman Building, Memphis, TN 38163-2857 | 2014-02-06 |
| 1396182705 | John W Fowler Jr. Md Pllc | Internal Medicine | 184 Colonial Rd, Memphis, TN 38117-3206 | 2013-05-24 |
| 1497198865 | Jeremy Scott Avila | Internal Medicine | 6799 Great Oaks Rd Ste 105, Memphis, TN 38138-2572 | 2013-04-16 |
| Find all providers in MEMPHIS | ||||
Please comment or provide details below to improve the information on SHANE CHARLES WILSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.