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NPI Code Detail

MEDICARE: KENNETH GIBBS MD

MEDICARE: KENNETH GIBBS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease PhysicianME44229FL
2207RC0000XCardiovascular Disease Physician41676KY
3207RI0011XInterventional Cardiology PhysicianME44229FL
4207RI0011XInterventional Cardiology Physician2016035277MO
5207RI0011XInterventional Cardiology PhysicianM-12671ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174506455
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH GIBBS MD
Provider Business Mailing Address
First Line : 415 6TH ST
Second Line :
City : LEWISTON
State : ID
Zip : 83501
Country : US
Telephone Number : 208-750-7445
Fax Number : 208-750-7445
Provider Business Practice Location Address
First Line : 415 6TH ST
Second Line :
City : LEWISTON
State : ID
Zip : 83501-2431
Country : US
Telephone Number : 208-750-7445
Fax Number : 208-750-7395
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2005
Last Update Date : 09/10/2020

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