MEDICARE: HIBP MEDICAL SERVICES INC.

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
1	261QH0100X	Health Service Clinic/Center	0841498	VA

General Provider Information

NPI Number	:	1982842753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIBP MEDICAL SERVICES INC.

Provider Business Mailing Address
First Line	:	6911 RICHMOND HWY
Second Line	:	SUITE # 425
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1842
Country	:	US
Telephone Number	:	703-417-9678
Fax Number	:	703-310-4039

Provider Business Practice Location Address
First Line	:	6911 RICHMOND HWY
Second Line	:	SUITE # 425
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1842
Country	:	US
Telephone Number	:	703-417-9678
Fax Number	:	703-310-4039

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GERMAN VALBUENA
Credential	:
Telephone Number	:	703-533-5560

Provider Enumeration Date	:	02/01/2009
Last Update Date	:	06/08/2015

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