Provider Demographics
NPI:1053321224
Name:VINCENT J TRIPI DO PA
Entity Type:Organization
Organization Name:VINCENT J TRIPI DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRIPI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:763-802-8200
Mailing Address - Street 1:1521 E MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-2222
Mailing Address - Country:US
Mailing Address - Phone:863-802-8200
Mailing Address - Fax:863-802-8100
Practice Address - Street 1:1521 E MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-2222
Practice Address - Country:US
Practice Address - Phone:863-802-8200
Practice Address - Fax:863-802-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS1373174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRAILRIOAD MEDICAREOtherDC5911
FLRAILRIOAD MEDICAREOtherDC5911