MEDICARE: JILL TRACEY SCHENK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146D00000X	Personal Emergency Response Attendant	A87051	CA
2	207Q00000X	Family Medicine Physician	DR-50806	CO
3	207Q00000X	Family Medicine Physician	A87051	CA
4	207Q00000X	Family Medicine Physician	04-49107	KS
5	207Q00000X	Family Medicine Physician	64183-20	WI
6	207Q00000X	Family Medicine Physician	33726	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00168917	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	240000	OTHER	OR	OMAP

General Provider Information

NPI Number	:	1770594475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL TRACEY SCHENK MD

Provider Business Mailing Address
First Line	:	1448 10TH AVE STE 304
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3579
Country	:	US
Telephone Number	:	304-691-6381
Fax Number	:	304-691-8591

Provider Business Practice Location Address
First Line	:	1600 MEDICAL CENTER DRIVE
Second Line	:	SUITE 1500
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3657
Country	:	US
Telephone Number	:	304-691-1100
Fax Number	:	304-691-1153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	08/23/2024

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Directions to “ JILL TRACEY SCHENK MD” Practice Location

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