Provider Demographics
NPI:1396907648
Name:GLEN H STRIBLING OD
Entity type:Organization
Organization Name:GLEN H STRIBLING OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-372-5914
Mailing Address - Street 1:5602 I 55 S
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-9402
Mailing Address - Country:US
Mailing Address - Phone:601-372-5914
Mailing Address - Fax:601-372-5921
Practice Address - Street 1:5602 I 55 S
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-9402
Practice Address - Country:US
Practice Address - Phone:601-372-5914
Practice Address - Fax:601-372-5921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS516332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0276240002OtherMEDICARE DME