1629026422 NPI number — MICHAEL D HIBBARD MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629026422 NPI number — MICHAEL D HIBBARD MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HIBBARD

Provider First Name:

MICHAEL

Provider Middle Name:

D

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1629026422

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/18/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 5009

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SIOUX FALLS

Provider Business Mailing Address State Name:

SD

Provider Business Mailing Address Postal Code:

57117-5009

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

605-977-5000

Provider Business Mailing Address Fax Number:

605-977-5377

Provider First Line Business Practice Location Address:

4520 W 69TH ST

Provider Second Line Business Practice Location Address:

NORTH CENTRAL HEART INSTITUTE

Provider Business Practice Location Address City Name:

SIOUX FALLS

Provider Business Practice Location Address State Name:

SD

Provider Business Practice Location Address Postal Code:

57108-8148

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

605-977-5000

Provider Business Practice Location Address Fax Number:

605-977-5377

Provider Enumeration Date:

05/04/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RI0011X , with the licence number:  3566 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RC0000X , with the licence number: 3566 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0003875 . This is a "SD BCBS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 165026 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 2997700 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 6002593 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 24678 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 7D930HI . This is a "MN BCBS - PLAN 91057NO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 052307100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 538R9HI . This is a "MN BCBS - PLAN 538R2NO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 3566 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 53990 . This is a "IA BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 931451029034 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".