Carol Lea Shackleton (NPI# 1629004759, PAC ID# 3870505043) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1629004759 |
| PAC ID by PECOS | 3870505043 |
| Professional Enrollment ID | I20060707000189 |
| Full Name | Carol Lea Shackleton |
| Organization Legal Name | GOTHENBURG MEMORIAL HOSPITAL |
| Address |
910 20th St Gothenburg NE 69138-1237 |
| Phone Number | 3085373661 |
| Gender | F |
| Credential | MD |
| Medical School | UNIVERSITY OF MINNESOTA MEDICAL SCHOOL |
| Graduation Year | 1981 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 6709832983 |
| Number of Group Practice Members | 10 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 281313 | GOTHENBURG MEMORIAL HOSPITAL |
| 280065 | GREAT PLAINS HEALTH |
| Address | Phone | Organization |
|---|---|---|
| 910 20th St, Gothenburg, NE 69138-1237 | 3085373661 | GOTHENBURG MEMORIAL HOSPITAL |
| Organization Legal Name | GOTHENBURG MEMORIAL HOSPITAL |
| Physicians | 9 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Ann M Scott | Nurse Practitioner | Gothenburg Memorial Hospital | 910 20th St, Gothenburg, NE 69138-1237 |
| Michael P Crisman | Physician Assistant | Gothenburg Memorial Hospital | 910 20th St, Gothenburg, NE 69138-1237 |
| Michelle K Chew | Nurse Practitioner | Gothenburg Memorial Hospital | 910 20th St, Gothenburg, NE 69138-1237 |
| Laurel A Walton | Obstetrics/gynecology | Gothenburg Memorial Hospital | 910 20th St, Gothenburg, NE 69138-1237 |
| Kayla S Knauss | Family Medicine | Gothenburg Memorial Hospital | 910 20th St, Gothenburg, NE 69138-1237 |
| Anna C Dalrymple | Family Medicine | Gothenburg Memorial Hospital | 114 N Main St, Brady Clinic, Brady, NE 69123-2749 |
| Aaron Isaiah Salomon | Physician Assistant | Gothenburg Memorial Hospital | 910 20th St, Gothenburg, NE 69138-1237 |
| Natalie A Waskowiak | Physician Assistant | Gothenburg Memorial Hospital | 114 N Main St, Brady Clinic, Brady, NE 69123-2749 |
| Street Address |
910 20TH ST |
| City | GOTHENBURG |
| State | NE |
| Zip | 69138-1237 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Ann M Scott | Nurse Practitioner | Gothenburg Memorial Hospital | 910 20th St, Gothenburg, NE 69138-1237 |
| Michael P Crisman | Physician Assistant | Gothenburg Memorial Hospital | 910 20th St, Gothenburg, NE 69138-1237 |
| Michelle K Chew | Nurse Practitioner | Gothenburg Memorial Hospital | 910 20th St, Gothenburg, NE 69138-1237 |
| Laurel A Walton | Obstetrics/gynecology | Gothenburg Memorial Hospital | 910 20th St, Gothenburg, NE 69138-1237 |
| Kayla S Knauss | Family Medicine | Gothenburg Memorial Hospital | 910 20th St, Gothenburg, NE 69138-1237 |
| Douglas W Beard | Orthopedic Surgery | Front Range Center for Brain and Spine Surgery, PC. | 910 20th St, Gothenburg, NE 69138-1237 |
| Aaron Isaiah Salomon | Physician Assistant | Gothenburg Memorial Hospital | 910 20th St, Gothenburg, NE 69138-1237 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Tiffany A Hicken | Chiropractic | 512 10th Ave, Gothenberg, NE 69138-1924 | |
| John A Gosnell | Optometry | 829 Lake Ave, Gothenburg, NE 69138-1943 | |
| Royce Lydell Hiebner | Chiropractic | 815 Lake Ave, Gothenburg, NE 69138-1943 | |
| Kimberly A Johnson | Optometry | 902 Ave D, Suite 102b, Gothenburg, NE 69138-1955 |
| City | GOTHENBURG |
| Zip Code | 69138 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | GOTHENBURG + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Carol Lea Shackleton.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.