1992947501 NPI number — GREGORY PIPPERT MD, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992947501 NPI number — GREGORY PIPPERT MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREGORY PIPPERT MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1992947501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4629 PINE POINT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARTELL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56377-9748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-542-4932
Provider Business Mailing Address Fax Number:
320-267-7968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7270 FORESTVIEW LN N
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
MAPLE GROVE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55369-5546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-542-4932
Provider Business Practice Location Address Fax Number:
866-542-6378
Provider Enumeration Date:
03/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PIPPERT
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
866-542-4932

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  37489 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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