Avery, Shane A

Avery, Shane A is an individual health care provider with primary practice located at 1469 North Gardner , Scottsburg IN 47170-0290. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Avery, Shane A can be contacted via phone (812) 752-1151.

Contact Information

Primary practice address
1469 North Gardner Scottsburg IN 47170-0290
Phone: (812) 752-1151
Fax: (812) 752-1152
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01045558A Indiana
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 01045558A Indiana

Profile Details

NPI number 1568452696
LBN Legal business name Avery, Shane A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 28th, 2005
Last updated Mar 7th, 2017 - about 7 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 1568452696 NPPES
Indiana MEDICAID 201163750A
Indiana Other 000000042772

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