Healthcare Provider Details

I. General information

NPI: 1609133719
Provider Name (Legal Business Name): KIRK JAMES HIPPENSTEEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KJ HIPPENSTEEL MD

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 W AGUA FRIA FWY STE 1090
PHOENIX AZ
85027-3970
US

IV. Provider business mailing address

PO BOX 80217
PHOENIX AZ
85060-0217
US

V. Phone/Fax

Practice location:
  • Phone: 623-848-4711
  • Fax:
Mailing address:
  • Phone: 602-385-2115
  • Fax: 480-418-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number147698
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number147698
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number71213
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number71213
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: