Provider Demographics
NPI:1295880391
Name:SHIREY & SHIREY M C
Entity type:Organization
Organization Name:SHIREY & SHIREY M C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHIREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-645-1117
Mailing Address - Street 1:17 RED OAKS SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-1348
Mailing Address - Country:US
Mailing Address - Phone:304-645-1117
Mailing Address - Fax:304-645-1148
Practice Address - Street 1:17 RED OAKS SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-1348
Practice Address - Country:US
Practice Address - Phone:304-645-1117
Practice Address - Fax:304-645-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV110049472OtherMEDICARE RAIL ROAD NUMBER
WV1306544SHIROtherUMWA NUMBER
WV0084194000Medicaid
WV0084194000Medicaid
WV110049472OtherMEDICARE RAIL ROAD NUMBER