MEDICARE: BIB, LLC

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	2085B0100X	Body Imaging Physician

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

General Provider Information

NPI Number	:	1366489247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIB, LLC

Provider Business Mailing Address
First Line	:	829 W CARPENTER ST
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015-3349
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11001 EXECUTIVE CENTER DR
Second Line	:	SUITE 200
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4316
Country	:	US
Telephone Number	:	501-812-7587
Fax Number	:	501-812-7588

Authorized Official
Title or Position	:	CHAIRMAN OF THE BOARD
Name	:	MR. MIKE TODD HECK
Credential	:
Telephone Number	:	501-202-4000

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	06/04/2008

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