| R. Mark Shivers Sole Mbr | |
|
214 Woodside Drive Salem OH 44460-7688 | |
| (330) 614-8411 | |
| (330) 244-8521 |
| Full Name | R. Mark Shivers Sole Mbr |
|---|---|
| Speciality | Family Medicine |
| Location | 214 Woodside Drive, Salem, Ohio |
| Authorized Official Name and Position | Richard Mark Shivers (OWNER / MD) |
| Authorized Official Contact | 3306148411 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| R. Mark Shivers Sole Mbr 4347 Portage St Nw Suite 102 North Canton OH 44720-7371 Ph: (330) 614-8411 | R. Mark Shivers Sole Mbr 214 Woodside Drive Salem OH 44460-7688 Ph: (330) 614-8411 |
| NPI Number | 1679239727 |
|---|---|
| Provider Enumeration Date | 11/12/2021 |
| Last Update Date | 11/16/2021 |
| Medicare PECOS PAC ID | 8820489107 |
|---|---|
| Medicare Enrollment ID | O20211221000547 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679239727 | NPI | - | NPPES |
| 0975995 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Richard Mark Shivers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639268352 PECOS PAC ID: 0840234688 Enrollment ID: I20101222000358 |
| Provider Name | Gabrielle Eisel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255912762 PECOS PAC ID: 1456746197 Enrollment ID: I20220316003091 |
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