Provider Demographics
NPI:1770594475
Name:SCHENK, JILL TRACEY (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:TRACEY
Last Name:SCHENK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:TRACEY
Other - Last Name:RUTTERS SCHENK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1448 10TH AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3579
Mailing Address - Country:US
Mailing Address - Phone:304-691-6381
Mailing Address - Fax:304-691-8591
Practice Address - Street 1:1600 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 1500
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3657
Practice Address - Country:US
Practice Address - Phone:304-691-1100
Practice Address - Fax:304-691-1153
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87051146D00000X, 207Q00000X
CODR-50806207Q00000X
KS04-49107207Q00000X
WI64183-20207Q00000X
WV33726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00168917OtherRAILROAD MEDICARE
CA00A870510Medicaid
AZ719834Medicaid
OR240000OtherOMAP
CO81058870Medicaid
COCOA 107167Medicare PIN
CAH67853Medicare UPIN
CA00A870510Medicaid
CA00A870510Medicare PIN