Provider Demographics
NPI:1285920447
Name:SECHRIST, JACOB W
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:W
Last Name:SECHRIST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5307
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-5307
Mailing Address - Country:US
Mailing Address - Phone:866-497-8222
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6379
Practice Address - Country:US
Practice Address - Phone:304-243-3270
Practice Address - Fax:304-243-2973
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4599722085R0202X
MDD00805642085R0202X
OH35.0827242085R0202X
WV308032085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1184697484Medicaid
PA103340232-0002Medicaid
OH2409870Medicaid