Provider Demographics
NPI:1811165210
Name:ALETHA W TIPPETT
Entity type:Organization
Organization Name:ALETHA W TIPPETT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALETHA
Authorized Official - Middle Name:W
Authorized Official - Last Name:TIPPETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-891-4508
Mailing Address - Street 1:10274 ALLIANCE RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4710
Mailing Address - Country:US
Mailing Address - Phone:513-891-4508
Mailing Address - Fax:
Practice Address - Street 1:10274 ALLIANCE RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-4710
Practice Address - Country:US
Practice Address - Phone:513-891-4508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9341291Medicare PIN