Basic Information
| Provider Information | |||||||||
| NPI: | 1831118702 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MINDEE J FLIPPIN MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3805 22ND ST | ||||||||
| Address2: | STE. 2A | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794101142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067610333 | ||||||||
| FaxNumber: | 8067222908 | ||||||||
| Practice Location | |||||||||
| Address1: | 3805 22ND ST | ||||||||
| Address2: | STE. 2A | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794101142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067714327 | ||||||||
| FaxNumber: | 8065774148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 01/29/2013 | ||||||||
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| AuthorizedOfficialLastName: | BUTCHER | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8067610333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | J7779 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 790090801 | 05 | TX | MEDICAID |