Provider Demographics
NPI:1679698641
Name:SIBLEY MEDICAL INCORPORATED
Entity Type:Organization
Organization Name:SIBLEY MEDICAL INCORPORATED
Other - Org Name:SIBLEY MEDICAL EQUIPMENT & SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FATIATU
Authorized Official - Middle Name:
Authorized Official - Last Name:JOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-237-7023
Mailing Address - Street 1:9831 GREENBELT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2202
Mailing Address - Country:US
Mailing Address - Phone:301-937-0188
Mailing Address - Fax:
Practice Address - Street 1:9831 GREENBELT ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6224
Practice Address - Country:US
Practice Address - Phone:301-937-0188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2462332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD012529600Medicaid
DC038680200Medicaid
VA1679698641Medicaid
DC038680200Medicaid