Provider Demographics
NPI:1962246637
Name:LIPSCOMB, RICHARD LEE
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
Last Name:LIPSCOMB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14835 BANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-9201
Mailing Address - Country:US
Mailing Address - Phone:269-721-3395
Mailing Address - Fax:269-721-3397
Practice Address - Street 1:441 BEDFORD RD N
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-1424
Practice Address - Country:US
Practice Address - Phone:269-721-3395
Practice Address - Fax:269-721-3395
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS1304183083747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty