Provider Demographics
NPI:1700069515
Name:BELL-MILBY, P.C.
Entity Type:Organization
Organization Name:BELL-MILBY, P.C.
Other - Org Name:POPO AGIE MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:TIBBETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-332-9973
Mailing Address - Street 1:504 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3032
Mailing Address - Country:US
Mailing Address - Phone:307-332-9973
Mailing Address - Fax:307-332-3488
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3032
Practice Address - Country:US
Practice Address - Phone:307-332-9973
Practice Address - Fax:307-332-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY364SP0808XOtherINDIVIDUAL TAXONOMY
WY1538236948OtherINDIVIDUAL NPI
WY1538236948OtherINDIVIDUAL NPI
WYMB0337421OtherDEA
WY1538236948OtherINDIVIDUAL NPI
WYW9880Medicare PIN