MEDICARE: MR. RANDAL DALE RIPPEY RVT

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	2471V0105X	Vascular Sonography Radiologic Technologist

General Provider Information

NPI Number	:	1235370313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDAL DALE RIPPEY RVT

Provider Business Mailing Address
First Line	:	5002 S COWAN LOOP
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-9780
Country	:	US
Telephone Number	:	573-864-9981
Fax Number	:

Provider Business Practice Location Address
First Line	:	5002 S COWAN LOOP
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-9780
Country	:	US
Telephone Number	:	573-864-9981
Fax Number	:

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

Provider Enumeration Date	:	03/18/2009
Last Update Date	:	03/18/2009

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