MEDICARE: DR. JOHN H SHUPERT 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	207Q00000X	Family Medicine Physician	35-083116	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00157248	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932148160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN H SHUPERT MD

Provider Business Mailing Address
First Line	:	1735 27TH ST
Second Line	:	WALLER BUILDING, SUITE B06
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-2677
Country	:	US
Telephone Number	:	740-356-8008
Fax Number	:	740-353-7900

Provider Business Practice Location Address
First Line	:	126 N CROSS ST
Second Line	:
City	:	WEST UNION
State	:	OH
Zip	:	45693-1209
Country	:	US
Telephone Number	:	937-544-8989
Fax Number	:	937-544-5659

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	05/15/2012

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Directions to “ DR. JOHN H SHUPERT MD” Practice Location

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