BRADLEY BIBB MD PLLC (NPI# 1871968388) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871968388 |
| Entity Type | Organization |
| Organization Name | BRADLEY BIBB MD PLLC |
| Practice Address |
201 S Bay Dr Bay AR 72411 |
| Mailing Address |
49 Highway 62 412 Ash Flat AR 72513-9594 |
| Practice Telephone | 8707701920 |
| Practice Fax Number | 8709947488 |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2020-02-03 |
| Authorized Official Name | BRADLEY BIBB (OWNER) |
| Authorized Official Telephone | 8709947301 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | E4136 | AR | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 201 South Bay Drive, Bay, AR 72411 | 8709947301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588015820 | Bradley Bibb Md Pllc | Clinic/Center | 2161 Ar 56 Highway, Calico Rock, AR 72519 | 2016-06-28 |
| 1639562432 | Bradley Bibb Md Pllc | Family Medicine | 10144 Highway 63 N Ste B, Bono, AR 72416 | 2015-03-18 |
| 1437569837 | Bradley Bibb Md Pllc | Clinic/Center | 3519 Highway 63, Black Rock, AR 72415 | 2014-05-07 |
| 1831595057 | Bradley Bibb Md Pllc | Clinic/Center | 202 Newsome Dr, Marked Tree, AR 72365-2021 | 2014-11-16 |
| 1699097436 | Bradley Bibb Md Pllc | Family Medicine | 49 Highway 62 412, Ash Flat, AR 72513-9594 | 2010-02-21 |
| Street Address |
201 S BAY DR |
| City | BAY |
| State | AR |
| Zip Code | 72411 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316557705 | Wanda Faye Mooney | Nurse Practitioner | 201 S Bay Dr, Bay, AR 72411-9482 | 2020-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598810384 | Bay School District 21 | Local Education Agency (LEA) | 700 School Street, Bay, AR 72411 | 2007-01-24 |
| 1649609520 | Hannah Leanne Riggs | Specialist/Technologist | 700 School Street, Bay, AR 72411 | 2013-11-01 |
| 1659702025 | Crissie Parks | Developmental Therapist | 614 N Bay Dr, Bay, AR 72411-9409 | 2013-12-10 |
| 1740622497 | Randi L Davis | Nurse Practitioner | 301 S Bay Dr, Bay, AR 72411-9482 | 2013-07-23 |
| 1497120596 | Phillip Carmer | Physical Therapist | 115 Terra Dr, Bay, AR 72411-9501 | 2015-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386704419 | Bhaskar Devanagondi | Specialist | 2110 16th St 1, Bay Pediatric Clinic, Bay, MI 48708 | 2006-12-11 |
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.