Healthcare Provider Details

I. General information

NPI: 1275084931
Provider Name (Legal Business Name): JOHN LIPINSKI HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 E CENTER DR STE A
ALTON IL
62002-5995
US

IV. Provider business mailing address

44 HAMPTON VILLAGE PLZ
SAINT LOUIS MO
63109-2127
US

V. Phone/Fax

Practice location:
  • Phone: 618-208-3250
  • Fax: 618-208-3261
Mailing address:
  • Phone: 314-481-6005
  • Fax: 314-481-4272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3287
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2008009334
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: