=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811165210
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALETHA W TIPPETT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2008
-----------------------------------------------------
Last Update Date | 12/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10274 ALLIANCE RD
-----------------------------------------------------
City | BLUE ASH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-4710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-891-4508
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10274 ALLIANCE RD
-----------------------------------------------------
City | BLUE ASH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-4710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-891-4508
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALETHA W TIPPETT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 513-891-4508
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------