Provider Demographics
NPI:1003852369
Name:SHIPMAN,EUCKER AND ASSOCIATES
Entity Type:Organization
Organization Name:SHIPMAN,EUCKER AND ASSOCIATES
Other - Org Name:SHIPMAN, EUCKER AND FEALKO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHIPM,AN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-372-0372
Mailing Address - Street 1:2652 ELM RD NE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9393
Mailing Address - Country:US
Mailing Address - Phone:800-292-3008
Mailing Address - Fax:330-629-9181
Practice Address - Street 1:2652 ELM RD NE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9393
Practice Address - Country:US
Practice Address - Phone:800-292-3008
Practice Address - Fax:330-629-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1546736OtherGATEWAY
OH000000179618OtherANTHEM BC BS
OH2222866Medicaid
OHCJ8412OtherRR MEDICARE
OH000000179618OtherANTHEM BC BS
OH1546736OtherGATEWAY
OH2222866Medicaid