Provider Demographics
NPI:1174666416
Name:PHIBBS, CAROL ANN
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:PHIBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HHA
Mailing Address - Street 1:64 EAST XENIA ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45335-1667
Mailing Address - Country:US
Mailing Address - Phone:937-675-7038
Mailing Address - Fax:
Practice Address - Street 1:1983 VERMONT DRIVE
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-4543
Practice Address - Country:US
Practice Address - Phone:937-372-3689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2578401Medicaid