1376514133 NPI number — VINCENT L KEIPPER MD

Table of content: VINCENT L KEIPPER MD (NPI 1376514133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376514133 NPI number — VINCENT L KEIPPER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEIPPER
Provider First Name:
VINCENT
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1376514133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
319 PENNY LN
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28025-1221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-403-7780
Provider Business Mailing Address Fax Number:
704-403-7781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 PENNY LN
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28025-1221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-403-7780
Provider Business Practice Location Address Fax Number:
704-403-7781
Provider Enumeration Date:
01/30/2006

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: 207R00000X , with the licence number:  21669 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4324689 . This is a "AETNA ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8118655 . This is a "MAMSI ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 110223581 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 111009 . This is a "WELLPATH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0440082 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8948035 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 48035 . This is a "BCBS ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6042 . This is a "PARTNERS MEDICARE CHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 232009 . This is a "MEDICARE OTHER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 26274 . This is a "MEDCOST ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 566000156 . This is a "PRACTICE TAX ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com