=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073705810
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIZBETH BIBLE, MD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2007
-----------------------------------------------------
Last Update Date | 08/15/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8662 N MAIN ST
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45415-1328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-890-8580
-----------------------------------------------------
Fax | 937-890-9652
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8662 N MAIN ST
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45415-1328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-890-8580
-----------------------------------------------------
Fax | 937-890-9652
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LIZBETH ANN BIBLE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 937-890-8580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 35084039
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------