Basic Information
| Provider Information | |||||||||
| NPI: | 1578595963 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHIPLEY | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | T. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636256 CENTRAL CREDENTIALING | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452636256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132453107 | ||||||||
| FaxNumber: | 5135855511 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 GOODMAN ST | ||||||||
| Address2: | DEPT. OF RADIOLOGY | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452671000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135842146 | ||||||||
| FaxNumber: | 5135840431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 02/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35-05-0619 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 009978615 | 05 | AL | MEDICAID | 0117234000 | 05 | WV | MEDICAID | 0557008 | 05 | OH | MEDICAID | 64784127 | 05 | KY | MEDICAID | 655263 | 01 | OH | AETNA | OTHER | 200039270A | 05 | IN | MEDICAID | 000000013959 | 01 | OH | ANTHEM | OTHER | 000903482X | 05 | GA | MEDICAID | 1620989 | 01 | OH | UNITED HEALTHCARE | OTHER | 300033848 | 01 | OH | MEDICARE RAILROAD | OTHER |