1003970278 NPI number — ROBERT B RIPCHINSKI PAC

Table of content: ROBERT B RIPCHINSKI PAC (NPI 1003970278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003970278 NPI number — ROBERT B RIPCHINSKI PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIPCHINSKI
Provider First Name:
ROBERT
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003970278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 LAUREL ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50314-3045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-247-8400
Provider Business Mailing Address Fax Number:
515-248-8888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 LAUREL ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50314-3045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-247-8400
Provider Business Practice Location Address Fax Number:
515-248-8888
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  002093 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50064554 . This is a "BLUECROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 271770007 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: P00386936 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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