Provider Demographics
NPI:1568904480
Name:BRADLEY BIBB, MD PLLC
Entity Type:Organization
Organization Name:BRADLEY BIBB, MD PLLC
Other - Org Name:ACCESS MEDICAL CLINIC DARDANELLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-994-7301
Mailing Address - Street 1:49 HIGHWAY 62 412
Mailing Address - Street 2:
Mailing Address - City:ASH FLAT
Mailing Address - State:AR
Mailing Address - Zip Code:72513-9594
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:870-994-7488
Practice Address - Street 1:1176 STATE HIGHWAY 22 W STE B
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834
Practice Address - Country:US
Practice Address - Phone:479-229-3004
Practice Address - Fax:870-994-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5G523OtherMEDICARE