Healthcare Provider Details

I. General information

NPI: 1336148683
Provider Name (Legal Business Name): CHIPPS, CAFFREY & DUBILIER, P.S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 BIG RUN RD
LEXINGTON KY
40503-2903
US

IV. Provider business mailing address

290 BIG RUN RD
LEXINGTON KY
40503-2903
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-9513
  • Fax: 859-277-6063
Mailing address:
  • Phone: 859-278-9513
  • Fax: 859-277-6063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON A CLARK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 859-278-9513