Provider Demographics
NPI:1033139597
Name:JAMES SHETTSLINE D.O. FAMILY PRACTICE
Entity Type:Organization
Organization Name:JAMES SHETTSLINE D.O. FAMILY PRACTICE
Other - Org Name:JAMES SHETTSLINE D.O. PRIMARY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHETTSLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-855-4700
Mailing Address - Street 1:57 W ORVILLA RD
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19440-3644
Mailing Address - Country:US
Mailing Address - Phone:215-855-4700
Mailing Address - Fax:215-361-9612
Practice Address - Street 1:57 W ORVILLA RD
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:PA
Practice Address - Zip Code:19440-3644
Practice Address - Country:US
Practice Address - Phone:215-855-4700
Practice Address - Fax:215-361-9612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003063L111N00000X
PADC003061L111N00000X
PADC043486L111N00000X
PAMD427337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA049755Medicare PIN