Basic Information
Provider Information | |||||||||
NPI: | 1144424698 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VORE | ||||||||
FirstName: | SHANA | ||||||||
MiddleName: | ALLIE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 100 JACKSON PIKE | ||||||||
Address2: |   | ||||||||
City: | GALLIPOLIS | ||||||||
State: | OH | ||||||||
PostalCode: | 456311560 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7404465000 | ||||||||
FaxNumber: | 7404465711 | ||||||||
Practice Location | |||||||||
Address1: | 100 JACKSON PIKE | ||||||||
Address2: |   | ||||||||
City: | GALLIPOLIS | ||||||||
State: | OH | ||||||||
PostalCode: | 456311560 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8554465937 | ||||||||
FaxNumber: | 7404465711 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/11/2007 | ||||||||
LastUpdateDate: | 09/13/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/13/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 26238 | WV | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | 35090525 | OH | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 2776474 | 05 | OH |   | MEDICAID | 3810027160 | 05 | WV |   | MEDICAID |