1013939883 NPI number — DR. PHILIP O DRIPCHAK MD

Table of content: DR. PHILIP O DRIPCHAK MD (NPI 1013939883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013939883 NPI number — DR. PHILIP O DRIPCHAK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRIPCHAK
Provider First Name:
PHILIP
Provider Middle Name:
O
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013939883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 950202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40295-0202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-588-9490
Provider Business Mailing Address Fax Number:
502-272-5116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8033 DIXIE HWY
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40258-1344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-449-6448
Provider Business Practice Location Address Fax Number:
502-449-6455
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  32284 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000026447X . This is a "NOTC/HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 106892 . This is a "NOTC/SIHO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4748794 . This is a "NOTC/CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50024279 . This is a "NOTC/PHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200964290 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3719526000 . This is a "NOTC/PAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000620765 . This is a "NOTC/ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64322845 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00761023 . This is a "NOTC/RAILROAD" identifier . This identifiers is of the category "OTHER".




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