1013063502 NPI number — RICHARD F ZIPF MD MEDICAL CORP

Table of content: (NPI 1013063502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013063502 NPI number — RICHARD F ZIPF MD MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD F ZIPF MD MEDICAL CORP
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:
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:
1013063502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4925 J STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACARAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95819-3828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-487-9198
Provider Business Mailing Address Fax Number:
916-481-1615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4925 J STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95819-3828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-487-9198
Provider Business Practice Location Address Fax Number:
916-481-1615
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZIPF
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
FERDINAND
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
916-487-9198

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  G11397 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00G113970 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180025520 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 958190000 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CGP128485 . This is a "CCS - STATE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ06498Z . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G113970 . This is a "BILLING ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1013063502 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 195715900 . This is a "DEPT. OF LABOR" identifier . This identifiers is of the category "OTHER".




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