1740353077 NPI number — DR. WAYNE E LIPSON MD

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 1740353077 NPI number — DR. WAYNE E LIPSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIPSON
Provider First Name:
WAYNE
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
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:
1740353077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CLINIC DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISONVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42431-1661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42431-1658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-326-3800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2006

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: 174400000X , with the licence number:  ME83852 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: 02113 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: 44161 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000289341 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3002128 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01080042 . This is a "RR MEDICARE TROVER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 5104835 . This is a "CIGNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810015990 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100122730 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7921468 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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