Provider Demographics
NPI:1821050170
Name:BIEBERLE, JAMIE J (RT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:J
Last Name:BIEBERLE
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 LAKIN AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3646
Mailing Address - Country:US
Mailing Address - Phone:620-792-5827
Mailing Address - Fax:620-792-2424
Practice Address - Street 1:3520 LAKIN AVE
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3646
Practice Address - Country:US
Practice Address - Phone:620-792-5827
Practice Address - Fax:620-792-2424
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS319252471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000130510Medicare NSC