1265412407 NPI number — DR. S. MATTHEW DIPIPPA D.C.

Table of content: DR. S. MATTHEW DIPIPPA D.C. (NPI 1265412407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265412407 NPI number — DR. S. MATTHEW DIPIPPA D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIPIPPA
Provider First Name:
S. MATTHEW
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1265412407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
662 NEW CASTLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTLER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16001-8338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-283-2424
Provider Business Mailing Address Fax Number:
724-283-2440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
662 NEW CASTLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTLER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16001-8338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-283-2424
Provider Business Practice Location Address Fax Number:
724-283-2440
Provider Enumeration Date:
01/21/2006

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: 111N00000X , with the licence number:  DC 005744-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 508389 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1648896 . This is a "BCBS GROUP#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 518922 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DC4546 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3688506 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 248577 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00169766 . This is a "RR MEDICARE PIN #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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