| Ken Lippincott, M.d., P.a. | |
|
4428 South Eason Boulevard Suite A Tupelo MS 38801-6506 | |
| (662) 844-3739 | |
| (662) 844-3728 |
| Full Name | Ken Lippincott, M.d., P.a. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4428 South Eason Boulevard, Tupelo, Mississippi |
| Authorized Official Name and Position | Charles Kenneth Lippincott (OWNER) |
| Authorized Official Contact | 6628443739 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ken Lippincott, M.d., P.a. 4428 South Eason Boulevard Suite A Tupelo MS 38801-6506 Ph: (662) 844-3739 | Ken Lippincott, M.d., P.a. 4428 South Eason Boulevard Suite A Tupelo MS 38801-6506 Ph: (662) 844-3739 |
| NPI Number | 1386673036 |
|---|---|
| Provider Enumeration Date | 07/02/2006 |
| Last Update Date | 01/03/2013 |
| Medicare PECOS PAC ID | 3476559980 |
|---|---|
| Medicare Enrollment ID | O20061005000493 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386673036 | NPI | - | NPPES |
| 09016260 | Medicaid | MS | |
| DG6420 | Other | MS | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 09148 (Mississippi) | Primary |
| Provider Name | Lisa T Lippincott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750416905 PECOS PAC ID: 5799830402 Enrollment ID: I20090902000165 |
| Provider Name | Charles K Lippincott |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376572123 PECOS PAC ID: 3274539796 Enrollment ID: I20100722000262 |
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