Provider Demographics
NPI:1861489080
Name:KEITH M. LIPSMEYER, M.D.P.A.
Entity Type:Organization
Organization Name:KEITH M. LIPSMEYER, M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIPSMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-354-2456
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-0677
Mailing Address - Country:US
Mailing Address - Phone:501-354-2456
Mailing Address - Fax:501-354-2458
Practice Address - Street 1:1711 N BUSINESS 9
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-4507
Practice Address - Country:US
Practice Address - Phone:501-354-2456
Practice Address - Fax:501-354-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B295Medicare ID - Type Unspecified