Provider Demographics
NPI:1346405909
Name:HIBBS, HAROLD (MD, MSC)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:
Last Name:HIBBS
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6582 W DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-7500
Mailing Address - Country:US
Mailing Address - Phone:317-800-3355
Mailing Address - Fax:317-800-3355
Practice Address - Street 1:1475 WEST OAK STREET #138
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077
Practice Address - Country:US
Practice Address - Phone:317-800-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63555-20207R00000X
OH35.129991207R00000X
IN01074935A208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1346405909Medicaid
WY1346405909OtherBCBS
WYW25828Medicare PIN
WYW25764Medicare PIN