Manda Loree Sloan-Van Bibber, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

95-PA-15 Issued in NM

Practice address

1501 San Pedro Dr SE
Albuquerque, NM 87108-5153

Phone

(505) 265-1711

NPI assigned

Oct 18, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Manda Loree Sloan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• Southwest Colorado Mental Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Dove Creek, CO
  • NPI 1699301671
  NPD
• Dolores County Health Association

  • Federally Qualified Health Center (FQHC)
  • Dove Creek, CO
  • NPI 1710954433
  NPD (past)

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625875200000",
    "number": "1699764092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 SAN PEDRO DR SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871085153",
            "telephone_number": "505-265-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 SAN PEDRO DR SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871085153",
            "telephone_number": "505-265-1711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2095 N Dolores Rd",
            "address_2": "2095 North Dolores Rd",
            "address_purpose": "LOCATION",
            "city": "Cortez",
            "state": "CO",
            "postal_code": "813218924",
            "country_code": "US",
            "telephone_number": "970-564-1037",
            "fax_number": "970-564-1041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SLOAN-VAN BIBBER",
        "first_name": "MANDA",
        "middle_name": "LOREE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-18",
        "last_updated": "2021-07-10",
        "certification_date": "2021-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NM",
            "license": "95-PA-15",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "572",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANDA",
            "last_name": "SLOAN",
            "middle_name": "LOREE",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Briana Slight, PHARMD
• Anthony Ray Slim
• Marcus Aldin Slim
• Jusemmy Haydee Slinkard, DMD
• Anita Lee Sloan-Garcia, MD
• John Henry Sloan, M.D.
• Lena Slocum, PA-S
• Jill A Slominski, MD
• SLS Therapy, LLC
• Elizabeth Danielle Sluder, OTR

• Medical Physician Assistant in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Medical Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2021; 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.