Provider Demographics
NPI:1366442683
Name:SHIPPY, SETH M (PA-C)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:M
Last Name:SHIPPY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 1750
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-756-5314
Mailing Address - Fax:713-756-8616
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 1842
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-756-5314
Practice Address - Fax:713-756-8616
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA03651363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202881302Medicaid
TX8702NCOtherBLUE CROSS BLUE SHIELD
TXP01298127OtherRR MEDICARE
TX8N3356OtherBCBS
TX202881301Medicaid
TX202881302Medicaid
TX202881301Medicaid
TX8N3356OtherBCBS