Provider Demographics
NPI:1699977488
Name:SHAW MEDICAL CENTER, PA
Entity type:Organization
Organization Name:SHAW MEDICAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-295-1121
Mailing Address - Street 1:220 SW WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4714
Mailing Address - Country:US
Mailing Address - Phone:817-295-1121
Mailing Address - Fax:817-295-8170
Practice Address - Street 1:220 SW WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4714
Practice Address - Country:US
Practice Address - Phone:817-295-1121
Practice Address - Fax:817-295-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCS3698OtherRAILROAD MEDICARE GROUP #
TX0080JKOtherBLUE SHIELD GROUP NUMBER