Provider Demographics
NPI:1386673036
Name:KEN LIPPINCOTT, M.D., P.A.
Entity Type:Organization
Organization Name:KEN LIPPINCOTT, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:LIPPINCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-844-3739
Mailing Address - Street 1:4428 SOUTH EASON BOULEVARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6506
Mailing Address - Country:US
Mailing Address - Phone:662-844-3739
Mailing Address - Fax:662-844-3728
Practice Address - Street 1:4428 SOUTH EASON BOULEVARD
Practice Address - Street 2:SUITE A
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6506
Practice Address - Country:US
Practice Address - Phone:662-844-3739
Practice Address - Fax:662-844-3728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS091482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016260Medicaid
MSDG6420OtherRAILROAD MEDICARE
MS260000598Medicare PIN
MSDG6420OtherRAILROAD MEDICARE