Provider Demographics
NPI:1205893484
Name:SCIPIONE, CHRISTOPHER M
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:M
Last Name:SCIPIONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1329
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-1329
Mailing Address - Country:US
Mailing Address - Phone:812-353-3087
Mailing Address - Fax:
Practice Address - Street 1:642 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454-9672
Practice Address - Country:US
Practice Address - Phone:812-723-7451
Practice Address - Fax:812-723-7508
Is Sole Proprietor?:No
Enumeration Date:2006-04-29
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076539207PE0004X
IN01067558A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4931837Medicaid
MI4931846Medicaid
IN200967600Medicaid
MI4931828Medicaid
MICS076539OtherBLUE CROSS BLUE SHIELD
IN200967600Medicaid
MICS076539OtherBLUE CROSS BLUE SHIELD
MI4931846Medicaid