MEDICARE: KIBLE HEALTH TX, P.A.

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician
2	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1104611565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIBLE HEALTH TX, P.A.

Provider Business Mailing Address
First Line	:	390 NE 191ST ST STE 8885
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-3899
Country	:	US
Telephone Number	:	646-904-4027
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 BRIERCROFT OFFICE PARK FL 2
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79412-3023
Country	:	US
Telephone Number	:	646-396-0527
Fax Number	:

Authorized Official
Title or Position	:	CAO
Name	:	SAMANTHA WU
Credential	:
Telephone Number	:	646-673-2983

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	03/17/2026

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Directions to “KIBLE HEALTH TX, P.A. ” Practice Location

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