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NPI Code Detail

MEDICARE: DR. RICHARD A SHORTER DO

MEDICARE: DR. RICHARD A SHORTER DO
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
1207Q00000XFamily Medicine Physician1105WV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
9P00173397OTHERWVRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1541839718OTHERC&O
2541839718107OTHERWVBS MOUNTAIN STATE
3262907OTHERCARELINK
44324131OTHERAETNA
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
75181179OTHERCCN
81038179OTHERWV WORKERS COMPENSATION

General Provider Information

NPI Number : 1770587172
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD A SHORTER DO
Provider Business Mailing Address
First Line : PO BOX 457
Second Line : 200 POCAHONTAS TRAIL
City : WHITE SULPHUR SPRINGS
State : WV
Zip : 24986-0457
Country : US
Telephone Number : 304-536-5030
Fax Number : 304-536-5051
Provider Business Practice Location Address
First Line : 904 HARRISON ST
Second Line :
City : PRINCETON
State : WV
Zip : 24740-3011
Country : US
Telephone Number : 304-461-7100
Fax Number : 304-461-7112
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 01/09/2025

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