1245496876 NPI number — DR. KIMBERLY BAILEY GIBBS M.D.

Table of content: DR. KIMBERLY BAILEY GIBBS M.D. (NPI 1245496876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245496876 NPI number — DR. KIMBERLY BAILEY GIBBS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBBS
Provider First Name:
KIMBERLY
Provider Middle Name:
BAILEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALDWELL
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245496876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4330 MEDICAL DR
Provider Second Line Business Mailing Address:
STE 500
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-3342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-576-5306
Provider Business Mailing Address Fax Number:
210-694-0645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4330 MEDICAL DR
Provider Second Line Business Practice Location Address:
STE 500
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-576-5306
Provider Business Practice Location Address Fax Number:
210-694-0645
Provider Enumeration Date:
08/04/2008

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: 207R00000X , with the licence number:  N3671 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: TXB156597 . This is a "WELLMED NETWORKS INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: TXB153511 . This is a "WELLMED MEDICAL GROUP PA" identifier . This identifiers is of the category "OTHER".