Provider Demographics
NPI:1558397281
Name:HIGH PLAINS TOTAL CARE LLC
Entity Type:Organization
Organization Name:HIGH PLAINS TOTAL CARE LLC
Other - Org Name:ROBERT VAUGHAN CIPPERLY MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VAUGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CIPPERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-565-0200
Mailing Address - Street 1:1925 E ORMAN AVE
Mailing Address - Street 2:STE A 235
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1925 E ORMAN AVE
Practice Address - Street 2:STE A 235
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3537
Practice Address - Country:US
Practice Address - Phone:719-565-0200
Practice Address - Fax:719-565-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38639332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44824785Medicaid
0619823OtherOTHER ID NUMBER-COMMERCIAL NUMBER