1205893484 NPI number — DR. CHRISTOPHER M SCIPIONE

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 1205893484 NPI number — DR. CHRISTOPHER M SCIPIONE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCIPIONE
Provider First Name:
CHRISTOPHER
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1205893484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1329
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47402-1329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-353-3087
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
642 W HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAOLI
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47454-9672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-723-7451
Provider Business Practice Location Address Fax Number:
812-723-7508
Provider Enumeration Date:
04/29/2006

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: 207PE0004X , with the licence number:  4301076539 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 01067558A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4931837 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4931846 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200967600 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4931828 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: CS076539 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 020024500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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