Provider Demographics
NPI:1336148683
Name:CHIPPS, CAFFREY & DUBILIER, P.S.C
Entity Type:Organization
Organization Name:CHIPPS, CAFFREY & DUBILIER, P.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-278-9513
Mailing Address - Street 1:290 BIG RUN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2903
Mailing Address - Country:US
Mailing Address - Phone:859-278-9513
Mailing Address - Fax:859-277-6063
Practice Address - Street 1:290 BIG RUN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2903
Practice Address - Country:US
Practice Address - Phone:859-278-9513
Practice Address - Fax:859-277-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65907834Medicaid
KY0581Medicare PIN
KY8014Medicare PIN
KY65907834Medicaid