Provider Demographics
NPI:1457654907
Name:HIBBETT PATIENT CARE
Entity Type:Organization
Organization Name:HIBBETT PATIENT CARE
Other - Org Name:HIBBETT PATIENT CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KNEELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:HIBBETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-764-4675
Mailing Address - Street 1:220 W TENNESSEE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5438
Mailing Address - Country:US
Mailing Address - Phone:256-764-4675
Mailing Address - Fax:256-764-4674
Practice Address - Street 1:220 W TENNESSEE ST STE 1
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5438
Practice Address - Country:US
Practice Address - Phone:256-764-4675
Practice Address - Fax:256-764-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1134593336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127903OtherPK