Bradley Bibb MD PLLC
Organization Active NPI Family Medicine Physician · Bay, AR
NPI 1871968388 · NPPES record last updated Feb 3, 2020
Key facts
- NPI
- 1871968388
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- E4136 (AR)
- Legal business name
- BRADLEY BIBB MD PLLC
- Practice address
- 201 S Bay Dr
Bay, AR 72411 - Phone
- (870) 770-1920
- Fax
- (870) 994-7488
- NPI assigned
- Dec 9, 2015
- Organization subpart
- No
Authorized official
- Name
- Bradley Bibb, M.D.
- Title
- Owner
- Phone
- (870) 994-7301
Other NPIs on the same Medicare enrollment 10
Practitioners 4
-
Sara Bayird, APRN
-
Allison Renee Gragg, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100628000488 | AR | Part B Supplier - Clinic/Group Practice | 4789715285 |
Receives reassigned benefits from 95 practitioners 11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ash Flat, AR; Black Rock, AR; Bono, AR; Dardanelle, AR; Hardy, AR; Marked Tree, AR; Salem, AR; Texarkana, AR |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | E4136 | AR | Yes |
Addresses
Primary practice location
201 S Bay Dr
Bay, AR 72411
Mailing address
49 Highway 62 412
Ash Flat, AR 72513-9594
Other practice location 1
201 south bay drive
bay, AR 72411
Phone (870) 994-7301
Other practice location 2
201 south bay drive
bay, AR 72411
Phone (870) 994-7301
Other providers in Bay, AR
- AMC FQHC Inc
- Bay School District 21
- Angela Burgess
- Phillip Carmer
- Randi L Davis
- Brittany K Fair
- Wanda Faye Mooney
All providers in Bay, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.