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General NPI Number Information
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NPI Number | 1154561116
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Entity Type | Organization
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Legal Business Name | JOSEPH W IPPOLITO JR MD PLLC
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 526 SHOUP AVE W SUITE F
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City | TWIN FALLS
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State | ID
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Zip | 83301-4591
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Country | US
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Telephone | 208-736-7620
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Fax | 208-735-9537
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Provider Business Mailing Address
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Address Line | 526 SHOUP AVE W SUITE F
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City | TWIN FALLS
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State | ID
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Zip | 83301-4591
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Country | US
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Telephone | 208-736-7620
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Fax | 208-735-9537
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Authorized Official
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Title or Position | MEDICAL DOCTOR/OWNER
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Name | DR. JOSEPH W IPPOLITO JR.
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Credential | MD
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Telephone | 208-736-7620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | M7008
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License Number State | ID
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