MEDICARE: DR. KIPP A. GOULD DO

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	207X00000X	Orthopaedic Surgery Physician	58.002044	OH

General Provider Information

NPI Number	:	1609071562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIPP A. GOULD DO

Provider Business Mailing Address
First Line	:	353 FAIRMONT BLVD
Second Line	:	ATTEN MEDICAL STAFF SERVICES
City	:	RAPID CITY
State	:	SD
Zip	:	57701-6000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2479 E COLORADO BLVD
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57783
Country	:	US
Telephone Number	:	605-644-4460
Fax Number	:	605-644-4461

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	02/05/2013

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