Prudencio Galvez Tible, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

MD00022189 Issued in WA

Practice address

5023 S Barton Place
Seattle, WA 98118

Phone

(206) 725-8043

Fax

(206) 760-1359

NPI assigned

Oct 16, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Prudencio G Tible MD PC

  dba Ranier Beach Medical Clinic

  • Clinic/Center
  • Seattle, WA
  • NPI 1053417675
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679663884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18936",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98118",
            "telephone_number": "206-725-8043",
            "fax_number": "206-760-1359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5023 S BARTON PLACE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98118",
            "telephone_number": "206-725-8043",
            "fax_number": "206-760-1359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBLE",
        "first_name": "PRUDENCIO",
        "middle_name": "GALVEZ",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WA",
            "license": "MD00022189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1035013",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julius Cesar Tiangson, RN
• Tibbi Healthcare LLC
• Jesse Anne Tibbits
• Mark Richard Tibeau, L.AC
• Laura Tiberio
• Anna Elyse Tibstra, LMFTA
• Tania Tiburcio
• Jerri Tice-Borden, MA
• Audrey Mae Tice, MFTA
• Connor Patrick Tice, MD

• General Practice Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• General Practice Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.