Provider Demographics
NPI:1801169396
Name:CHARLES H RIPP, MD PC
Entity type:Organization
Organization Name:CHARLES H RIPP, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:RIPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-577-9124
Mailing Address - Street 1:DEPT 0913
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0913
Mailing Address - Country:US
Mailing Address - Phone:719-577-9063
Mailing Address - Fax:719-577-9124
Practice Address - Street 1:1625 MEDICAL CENTER PT
Practice Address - Street 2:SUITE 240
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8731
Practice Address - Country:US
Practice Address - Phone:719-577-9063
Practice Address - Fax:719-577-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR-27928208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE04730Medicare UPIN