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General NPI Number Information
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NPI Number | 1245584747
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Entity Type | Organization
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Legal Business Name | BIBB FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 100 BUSINESS PARK DR SUITE A
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City | RIDGELAND
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State | MS
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Zip | 39157-6015
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Country | US
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Telephone | 601-259-0083
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 41
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City | TOUGALOO
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State | MS
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Zip | 39174-0041
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | KIMBERLY BIBB
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Credential | M.D.
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Telephone | 601-259-0083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 19334
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License Number State | MS
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