Provider Demographics
NPI:1699184804
Name:RON LIPPMANN DO PA
Entity Type:Organization
Organization Name:RON LIPPMANN DO PA
Other - Org Name:MEDSOUTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPPMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:850-215-8999
Mailing Address - Street 1:509 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5307
Mailing Address - Country:US
Mailing Address - Phone:850-215-8999
Mailing Address - Fax:850-215-8681
Practice Address - Street 1:509 E 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5307
Practice Address - Country:US
Practice Address - Phone:850-215-8999
Practice Address - Fax:850-215-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7517261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010163100Medicaid
FLK8396AMedicare UPIN