MEDICARE: NORTH SIDE INTERNAL MEDICINE PLLC

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	261QM2500X	Medical Specialty Clinic/Center	18076	OK

General Provider Information

NPI Number	:	1497743181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH SIDE INTERNAL MEDICINE PLLC

Provider Business Mailing Address
First Line	:	6957 NW EXPRESSWAY
Second Line	:	SUITE #301
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-3533
Country	:	US
Telephone Number	:	405-749-1484
Fax Number	:	405-749-1484

Provider Business Practice Location Address
First Line	:	6957 NW EXPRESSWAY
Second Line	:	SUITE #301
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-3533
Country	:	US
Telephone Number	:	405-749-1484
Fax Number	:	405-749-1484

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. JON CHRISTOPHER LIPRIE
Credential	:	MD
Telephone Number	:	405-749-1484

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	08/22/2020

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