Basic Information
| Provider Information | |||||||||
| NPI: | 1821387861 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | SHAWN | ||||||||
| MiddleName: | T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 HIGHWAY J | ||||||||
| Address2: | |||||||||
| City: | HAYTI | ||||||||
| State: | MO | ||||||||
| PostalCode: | 638511200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733592600 | ||||||||
| FaxNumber: | 5733591103 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 HIGHWAY J | ||||||||
| Address2: | |||||||||
| City: | HAYTI | ||||||||
| State: | MO | ||||||||
| PostalCode: | 638511200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733592600 | ||||||||
| FaxNumber: | 5733591103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2011 | ||||||||
| LastUpdateDate: | 03/30/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251V00000X | Y | Agencies | Voluntary or Charitable |
No ID Information.