Provider Demographics
NPI:1780736363
Name:GRETCHEN M SIBLEY, DO PA
Entity type:Organization
Organization Name:GRETCHEN M SIBLEY, DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-443-2400
Mailing Address - Street 1:915 MAYNE ST
Mailing Address - Street 2:
Mailing Address - City:GYPSUM
Mailing Address - State:CO
Mailing Address - Zip Code:81637-9756
Mailing Address - Country:US
Mailing Address - Phone:207-841-5489
Mailing Address - Fax:
Practice Address - Street 1:915 MAYNE ST
Practice Address - Street 2:
Practice Address - City:GYPSUM
Practice Address - State:CO
Practice Address - Zip Code:81637-9756
Practice Address - Country:US
Practice Address - Phone:207-841-5489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEG39038OtherHARVARD PILGRIM
ME333930000Medicaid
ME3552748OtherAETNA
ME3552748OtherAETNA
G39038Medicare UPIN