MEDICARE: DR. MARK B KIPP MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	L1910	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8B7646	OTHER	TX	BCBS THRU AEMA
2	8BT323	OTHER	TX	BCBS THRU SAEMA
3	P00869641	OTHER	TX	RRMCARE THRU SAEMA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	P00148167	OTHER	TX	RAILROAD THRU AEMA

General Provider Information

NPI Number	:	1235108895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK B KIPP MD

Provider Business Mailing Address
First Line	:	5500 SYCAMORE SCHOOL RD STE 150
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-3053
Country	:	US
Telephone Number	:	682-707-9707
Fax Number	:	682-707-9708

Provider Business Practice Location Address
First Line	:	800 W RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-2504
Country	:	US
Telephone Number	:	817-548-6202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	10/08/2025

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