MEDICARE: DR. CHARLES KENNETH LIPPINCOTT

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	2084P0800X	Psychiatry Physician	09148	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00093379	OTHER	MS	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376572123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES KENNETH LIPPINCOTT

Provider Business Mailing Address
First Line	:	4428 SOUTH EASON BOULEVARD
Second Line	:	SUITE A
City	:	TUPELO
State	:	MS
Zip	:	38801-6506
Country	:	US
Telephone Number	:	662-844-3739
Fax Number	:	662-844-3728

Provider Business Practice Location Address
First Line	:	4428 SOUTH EASON BOULEVARD
Second Line	:	SUITE A
City	:	TUPELO
State	:	MS
Zip	:	38801-6506
Country	:	US
Telephone Number	:	662-844-3739
Fax Number	:	662-844-3728

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	08/01/2013

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