Short, Yancy S
Short, Yancy S is an individual health care provider with primary practice located at 211 W Maple Ave Ste A , Fayetteville WV 25840-1445. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Short, Yancy S can be contacted via phone (304) 900-5511.Contact Information
Primary practice address
211 W Maple Ave Ste A
Fayetteville WV 25840-1445
Phone: (304) 900-5511
Fax: (304) 900-5558
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 16555 | West Virginia |
Profile Details
| NPI number | 1265429831 |
|---|---|
| LBN Legal business name | Short, Yancy S |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 29th, 2005 |
| Last updated | Sep 17th, 2020 - about 5 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 | 1265429831 | NPPES |
| West Virginia | MEDICAID | 004522000 | |
| West Virginia | Other | P01600108 |
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