1285623181 NPI number — TIMOTHY J GIBBS PT, OCS, CERT. MDT

Table of content: TIMOTHY J GIBBS PT, OCS, CERT. MDT (NPI 1285623181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285623181 NPI number — TIMOTHY J GIBBS PT, OCS, CERT. MDT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBBS
Provider First Name:
TIMOTHY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, OCS, CERT. MDT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285623181
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 COMMONS LOOP
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59901-1904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-752-7250
Provider Business Mailing Address Fax Number:
406-752-6250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 COMMONS LOOP
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
KALISPELL
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59901-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-752-7250
Provider Business Practice Location Address Fax Number:
406-752-6250
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1141PT , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BCBS OF MT . This is a "PROVIDER NUMBER" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: P00380494 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: WA STATE COMP FUND . This is a "PROVIDER # FOR WA PATIENT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0049348 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: MT STATE FUND . This is a "PROVIDER NUMBER" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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