Provider Demographics
NPI:1932431772
Name:SAMUEL J. PIPES, D.O., INC.
Entity Type:Organization
Organization Name:SAMUEL J. PIPES, D.O., INC.
Other - Org Name:SAMUEL PIPES, D.O., INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PIPES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-847-7217
Mailing Address - Street 1:5975 MAHONING AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-1190
Mailing Address - Country:US
Mailing Address - Phone:330-847-7217
Mailing Address - Fax:330-847-0563
Practice Address - Street 1:5975 MAHONING AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1190
Practice Address - Country:US
Practice Address - Phone:330-847-7217
Practice Address - Fax:330-847-0563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000160426OtherUNISON
OH000000130557OtherANTHEM
OH0256977Medicaid
OH4610331OtherAETNA
OH791011752OtherRAILROAD MEDICARE
OH0101892OtherUNITED HEALTHCARE
OH59277OtherQUALCHOICE
OH4610331OtherAETNA
OH59277OtherQUALCHOICE