MEDICARE: ALAN MATTHEW TRIPP D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	04032	KY
2	208600000X	Surgery Physician	02004102A	IN
3	208600000X	Surgery Physician	1876	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00000793150	OTHER	IN	BCBS

General Provider Information

NPI Number	:	1396829925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN MATTHEW TRIPP D.O.

Provider Business Mailing Address
First Line	:	1305 N ELM ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-2783
Country	:	US
Telephone Number	:	270-631-2412
Fax Number	:	270-827-7558

Provider Business Practice Location Address
First Line	:	1413 N ELM ST
Second Line	:	SUITE 204
City	:	HENDERSON
State	:	KY
Zip	:	42420-2768
Country	:	US
Telephone Number	:	270-830-9973
Fax Number	:	270-830-9975

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	10/19/2016

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Directions to “ ALAN MATTHEW TRIPP D.O.” Practice Location

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