Healthcare Provider Details

I. General information

NPI: 1295653483
Provider Name (Legal Business Name): ALBERT TIBBS JR. PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6607 STATE ROUTE 93
PEDRO OH
45659-8912
US

IV. Provider business mailing address

6607 STATE ROUTE 93
PEDRO OH
45659-8912
US

V. Phone/Fax

Practice location:
  • Phone: 740-646-9734
  • Fax:
Mailing address:
  • Phone: 740-646-9734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberWV063112
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number1055299
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number109876
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: