Basic Information
| Provider Information | |||||||||
| NPI: | 1578777538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASE-LIPTON | ||||||||
| FirstName: | VIVIAN | ||||||||
| MiddleName: | RUTH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GILES | ||||||||
| OtherFirstName: | VIVIAN | ||||||||
| OtherMiddleName: | RUTH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 724 N SPRING ST STE A | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726012913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703650850 | ||||||||
| FaxNumber: | 8703650862 | ||||||||
| Practice Location | |||||||||
| Address1: | 724 N SPRING ST STE A | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726012913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703650850 | ||||||||
| FaxNumber: | 8703650862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | BP10056154 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 175M00000X | 6120783-3400 | UT | N | Other Service Providers | Midwife, Lay | 207Q00000X | E-15623 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.