1124088802 NPI number — DR. RICHARD H TIPPETS M.D.

Table of content: DR. RICHARD H TIPPETS M.D. (NPI 1124088802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124088802 NPI number — DR. RICHARD H TIPPETS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIPPETS
Provider First Name:
RICHARD
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1124088802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5171 COTTONWOOD ST
Provider Second Line Business Mailing Address:
STE 950
Provider Business Mailing Address City Name:
MURRAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84107-5704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-507-9555
Provider Business Mailing Address Fax Number:
801-507-9550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5171 COTTONWOOD ST
Provider Second Line Business Practice Location Address:
STE 950
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107-5704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-507-9555
Provider Business Practice Location Address Fax Number:
801-507-9550
Provider Enumeration Date:
03/25/2006

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: 207T00000X , with the licence number:  1748671205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 52479 . This is a "DESERET MUTUAL (DMBA)" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870639983T12 . This is a "EDUCATORS MUTUAL (EMIA)" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 47150 . This is a "PUBLIC EMPLOYEES (PEHP)" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107005609104 . This is a "INTERMOUNTAIN HEALTHCARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com