Individual
DR. JACOB WAYNE SHIPLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
126 E CHURCH ST STE 2400, SOMERSET, PA 15501
(814) 443-5800
(814) 443-5499
Mailing address
329 S PLEASANT AVE, SOMERSET, PA 15501-2262
(814) 445-3575
(814) 445-5700
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
MD450197
PA
207LP2900X
Pain Medicine (Anesthesiology) Physician
35.123054
OH
208VP0000X
Pain Medicine Physician
Primary
MD450197
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000873681
ANTHEM BCBS
OH
05
—
0015083500031
—
PA
01
—
002533543
HIGHMARK BLUE SHIELD
PA
01
—
12700751
CAQH
OH
01
—
618271100
ACS DEPT OF LABOR WC
OH
01
—
710929
MEDICARE
PA
01
—
CI6140
RAILROAD MEDICARE
PA
01
—
H318750
MEDICARE PTAN
OH
Enumeration date
07/28/2009
Last updated
03/08/2021
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