Provider Demographics
NPI:1356372866
Name:R FLIPPIN SC
Entity type:Organization
Organization Name:R FLIPPIN SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLIPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-444-9242
Mailing Address - Street 1:PO BOX 16557
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-0557
Mailing Address - Country:US
Mailing Address - Phone:414-444-9242
Mailing Address - Fax:414-444-9252
Practice Address - Street 1:3915 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2528
Practice Address - Country:US
Practice Address - Phone:414-444-9242
Practice Address - Fax:414-444-9252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43241000Medicaid
WIDG2799OtherRAILROAD MEDICARE
IL09932334OtherBLUE CROSS BLUE SHIELD
WI43269500Medicaid
WI5602619OtherMEDICAID HMO
WI43269500Medicaid
WI5602619OtherMEDICAID HMO
WI43269500Medicaid