Provider Demographics
NPI:1588106108
Name:TIBBITTS TRANSPORTATION
Entity type:Organization
Organization Name:TIBBITTS TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIBBITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-881-8787
Mailing Address - Street 1:772 N 4000 E
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5063
Mailing Address - Country:US
Mailing Address - Phone:208-881-8787
Mailing Address - Fax:
Practice Address - Street 1:772 N 4000 E
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5063
Practice Address - Country:US
Practice Address - Phone:208-881-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)