MEDICARE: IBEX, 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	253Z00000X	In Home Supportive Care Agency	04J542	CO
2	251E00000X	Home Health Agency	04J542	CO

General Provider Information

NPI Number	:	1750826400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IBEX, LLC

Provider Business Mailing Address
First Line	:	1902 E BOULDER ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5839
Country	:	US
Telephone Number	:	719-634-4999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1902 E BOULDER ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5839
Country	:	US
Telephone Number	:	719-634-4999
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PETER VANDERBROUK
Credential	:
Telephone Number	:	719-634-4999

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	01/04/2017

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