Shipley, Jacob Wayne
Shipley, Jacob Wayne is an individual health care provider with primary practice located at 126 E Church St Ste 2400 , Somerset PA 15501. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Shipley, Jacob Wayne can be contacted via phone (814) 443-5800.Contact Information
Primary practice address
126 E Church St Ste 2400
Somerset PA 15501
Phone: (814) 443-5800
Fax: (814) 443-5499
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | MD450197 | Pennsylvania |
| Allopathic & Osteopathic Physicians / Pain Medicine | 207LP2900X | 35.123054 | Ohio |
| Allopathic & Osteopathic Physicians / Pain Medicine | 208VP0000X | MD450197 | Pennsylvania |
Profile Details
| NPI number | 1063643856 |
|---|---|
| LBN Legal business name | Shipley, Jacob Wayne |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 28th, 2009 |
| Last updated | Mar 8th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063643856 | NPPES |
| Ohio | Other | H318750 | MEDICARE PTAN |
| Ohio | Other | CI6140 | MEDICARE PTAN |
| Ohio | Other | 618271100 | MEDICARE PTAN |
| Ohio | MEDICAID | 0015083500031 | MEDICARE PTAN |
| Ohio | Other | 002533543 | MEDICARE PTAN |
| Ohio | Other | 000000873681 | MEDICARE PTAN |
| Ohio | Other | 12700751 | MEDICARE PTAN |
| Ohio | Other | 710929 | MEDICARE PTAN |
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