MEDICARE: DR. DIANE HIBBS D.O.

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	207V00000X	Obstetrics & Gynecology Physician	3356	OK
2	207V00000X	Obstetrics & Gynecology Physician	4746	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	243326007	OTHER	OK	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	90110053	OTHER	OK	PACIFIC CARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265436604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE HIBBS D.O.

Provider Business Mailing Address
First Line	:	2702 N. 3RD ST.
Second Line	:	STE. 4020
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1130
Country	:	US
Telephone Number	:	602-323-3242
Fax Number	:	602-323-3496

Provider Business Practice Location Address
First Line	:	635 E. BASELINE RD.
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042
Country	:	US
Telephone Number	:	602-243-7277
Fax Number	:	602-243-1235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/24/2009

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Directions to “ DR. DIANE HIBBS D.O.” Practice Location

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