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NPI Code Detail

MEDICARE: KIBBS FORTILUS BS

MEDICARE: KIBBS FORTILUS BS
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1073456141
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIBBS FORTILUS BS
Provider Business Mailing Address
First Line : 80 COMMERCIAL ST
Second Line :
City : HOLYOKE
State : MA
Zip : 01040-4704
Country : US
Telephone Number : 413-846-0446
Fax Number : 413-846-0447
Provider Business Practice Location Address
First Line : 80 COMMERCIAL ST
Second Line :
City : HOLYOKE
State : MA
Zip : 01040-4704
Country : US
Telephone Number : 413-846-0446
Fax Number : 413-846-0447
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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Directions to “ KIBBS FORTILUS BS” Practice Location

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