Provider Demographics
NPI:1063192847
Name:KIBBE ORTHOPEDICS PLLC
Entity type:Organization
Organization Name:KIBBE ORTHOPEDICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:KIBBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-834-5676
Mailing Address - Street 1:PO BOX 33149
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0609
Mailing Address - Country:US
Mailing Address - Phone:888-488-8289
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:209 HIGH POINT CT STE 100
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-5512
Practice Address - Country:US
Practice Address - Phone:502-834-5676
Practice Address - Fax:833-700-1693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies