Healthcare Provider Details

I. General information

NPI: 1770594475
Provider Name (Legal Business Name): JILL TRACEY SCHENK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL TRACEY RUTTERS SCHENK MD

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/23/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DRIVE SUITE 1500
HUNTINGTON WV
25701-3657
US

IV. Provider business mailing address

1448 10TH AVE STE 304
HUNTINGTON WV
25701-3579
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1100
  • Fax: 304-691-1153
Mailing address:
  • Phone: 304-691-6381
  • Fax: 304-691-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberA87051
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR-50806
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA87051
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-49107
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number64183-20
License Number StateWI
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33726
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: