| Jack M. Shields,m.d., Pa | |
|
20 Magnolia Ave Building B , Suite C Bridgeton NJ 08302-1759 | |
| (856) 455-8833 | |
| Not Available |
| Full Name | Jack M. Shields,m.d., Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 20 Magnolia Ave, Bridgeton, New Jersey |
| Authorized Official Name and Position | Jack M. Shields (CEO/PRESIDENT) |
| Authorized Official Contact | 8564558833 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack M. Shields,m.d., Pa 20 Magnolia Ave Building B , Suite C Bridgeton NJ 08302-1759 Ph: (856) 455-8833 | Jack M. Shields,m.d., Pa 20 Magnolia Ave Building B , Suite C Bridgeton NJ 08302-1759 Ph: (856) 455-8833 |
| NPI Number | 1245425206 |
|---|---|
| Provider Enumeration Date | 09/12/2007 |
| Last Update Date | 09/13/2007 |
| Medicare PECOS PAC ID | 4688847023 |
|---|---|
| Medicare Enrollment ID | O20111101000298 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245425206 | NPI | - | NPPES |
| 3019501 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MA35038 (New Jersey) | Primary |
| Provider Name | Jack M Shields |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730119934 PECOS PAC ID: 6901850825 Enrollment ID: I20050303000519 |
| Provider Name | Lorraine M Santucci |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538154349 PECOS PAC ID: 6800840604 Enrollment ID: I20050307000017 |
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