NPI age
20 years
Enumerated 2005-10-14
● Active
Type 1 · Individual
DR. Shane Keith Anderson, D.O.
Anderson is 1 of 1 internal medicine providers in Malad City and 1 of 504 in Idaho.
Primary specialty
Internal Medicine
Plus 1 subspecialty
Licensed in
MT, MO
2 states
Status
Active
No deactivations on record
Last NPPES update
2011-05-24
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 504 active internal medicine providers in Idaho.
NPI age
20 years
↑ 4 yr above median (16 yr)
State licenses
2 states
Top 76% — 23% of peers are multi-state
Subspecialties
0
44% of peers hold subspecialties
NPI lifetime · 2005 → 2026
2005-10Enumerated in NPPES
2005
2026
Where they practice
Practice location
220 Bannock St
Malad City, ID 832521256
Mailing address
Po Box 126
Malad City, ID 832520126
Specialties
-
Internal Medicine PrimaryA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer,...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (MO) | 000092769 | PROVIDER NUMBER |
Multi-state credentialing: Licensed in 2 states. Useful context for credentialers building cross-state provider networks.
Practice context
Part of a multi-provider practice. 15 other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.