Provider Demographics
NPI:1669879532
Name:LYNDSAY R SHIPP MD PLLC
Entity type:Organization
Organization Name:LYNDSAY R SHIPP MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLMSTEAD-MCCRANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-371-1326
Mailing Address - Street 1:PO BOX 1158
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-1158
Mailing Address - Country:US
Mailing Address - Phone:623-711-3266
Mailing Address - Fax:662-371-1325
Practice Address - Street 1:705 SISK AVE STE 105
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-3413
Practice Address - Country:US
Practice Address - Phone:662-371-1326
Practice Address - Fax:662-236-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05408509Medicaid