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Organization
JOSEPH W IPPOLITO JR MD PLLC
Active
Organization
JOSEPH W IPPOLITO JR MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH W IPPOLITO JR. MD (MEDICAL DOCTOR/OWNER)
(208) 736-7620
Entity
Organization
Contact information
Practice address
526 SHOUP AVE W, SUITE F, TWIN FALLS, ID 83301-4591
(208) 736-7620
(208) 735-9537
Mailing address
526 SHOUP AVE W, SUITE F, TWIN FALLS, ID 83301-4591
(208) 736-7620
(208) 735-9537
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
M7008
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010001696
REGENCE BLUE SHIELD OF IDAHO
ID
05
—
003755600
—
ID
01
—
DY066
BLUE CROSS OF IDAHO
ID
Enumeration date
03/03/2009
Last updated
08/29/2012
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