Basic Information
| Provider Information | |||||||||
| NPI: | 1164536512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIPSMEYER | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8351 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761240351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174514208 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6800 STATE ROUTE 162 | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620628500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182885711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 09/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 36-116105 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 0432906 | KS | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 35.094674 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 2006029618 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 0101246429 | VA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD60132287 | WA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD.32515 | AL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 22512 | MS | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | Q1440 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD38533 | IA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 01067277A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 45360 | KY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 303380 | LA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 4301081397 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 46236 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036116105 | 05 | IL | MEDICAID | 1164536512 | 05 | VA | MEDICAID | 11647536512 | 05 | ID | MEDICAID | 7100146810 | 05 | KY | MEDICAID | P00657549 | 01 | MO | RR MEDICARE | OTHER | 1164536512 | 01 | IA | BLUE SHIELD | OTHER | 1164536512 | 05 | MO | MEDICAID | 68323 | 01 | FL | BC BS OF FL | OTHER | 1164536512 | 05 | IA | MEDICAID | 1521057 | 05 | TN | MEDICAID | 200423200D | 05 | KS | MEDICAID | BL9795824 | 01 | DEA CERTIFICATE | OTHER | 06032182 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER | 1164536512 | 05 | WA | MEDICAID | 3006106 | 05 | OH | MEDICAID | 000386700 | 05 | FL | MEDICAID | 1720253172 | 05 | MT | MEDICAID | 1164536512 | 01 | KS | BCBS | OTHER | 3810018865 | 05 | WV | MEDICAID |