MEDICARE: DIANE C LIPSCOMB M.D.

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	2080P0203X	Pediatric Critical Care Medicine Physician	2012034747	MO

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	431560263	OTHER	MO	TRICARE
4	P01116103	OTHER	MO	RR MCR
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780677732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE C LIPSCOMB M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2580
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65801-2580
Country	:	US
Telephone Number	:	417-829-4620
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 E CHEROKEE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2203
Country	:	US
Telephone Number	:	417-829-5400
Fax Number	:	417-820-7129

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	03/09/2026

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