Mountain West Derm - Blackhart PLLC
NPI 1891467577ActiveOrganization· Dermatology· Roseburg, OR
Dermatology in Roseburg, Oregon, registered in NPPES in October 2021. The authorized official on file is Jeffrey B. Shackelton, MD, Owner.
Overview
| NPI | 1891467577 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Oct 1, 2021 |
| Last updated in NPPES | Oct 4, 2021 |
| Certified by provider | Oct 4, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dermatology Primary | 207N00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Other Dermatology providers in Roseburg
- 1255520383
- 1891850814
- 1326496522
- 1447222724
- 1467475137
- 1134449366