1881685220 NPI number — GLEN H STRIBLING OD

Table of content: GLEN H STRIBLING OD (NPI 1881685220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881685220 NPI number — GLEN H STRIBLING OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRIBLING
Provider First Name:
GLEN
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1881685220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 E GEORGETOWN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRYSTAL SPRINGS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39059-2746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-892-5053
Provider Business Mailing Address Fax Number:
601-892-5741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 E GEORGETOWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRYSTAL SPRINGS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39059-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-892-5053
Provider Business Practice Location Address Fax Number:
601-892-5741
Provider Enumeration Date:
11/03/2005

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: 152W00000X , with the licence number:  516 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00087004 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410044093 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com