Provider Demographics
NPI:1720035496
Name:STEPHEN W. HIPP, M.D., P.A.
Entity Type:Organization
Organization Name:STEPHEN W. HIPP, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-377-1663
Mailing Address - Street 1:1718 E 4TH ST
Mailing Address - Street 2:607
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3260
Mailing Address - Country:US
Mailing Address - Phone:704-377-1663
Mailing Address - Fax:704-377-8051
Practice Address - Street 1:1718 E 4TH ST
Practice Address - Street 2:607
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3260
Practice Address - Country:US
Practice Address - Phone:704-377-1663
Practice Address - Fax:704-377-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28417174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
232199OtherPARTNERS
0175UOtherBCBS
NC8942599Medicaid
0175UOtherBCBS