Bradley Bibb MD PLLC
Clinic/Center, Rural Health in Ponca City, OK. Organization (NPI-2).
NPI number1194572040
StatusActive
Last updated in NPPESOct 2, 2024
Details
- NPI
- 1194572040
- Entity type
- Organization (NPI-2)
- Legal business name
- Bradley Bibb MD PLLC
- Organization subpart
- No
- Enumeration date
- Apr 30, 2024
- Certification date
- Oct 2, 2024
- Last updated
- Oct 2, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR1300X | Clinic/Center, Rural Health | – | – | Yes |
| 207Q00000X | Family Medicine | – | – |
Practice location
1201 E Hartford AvePonca City, OK 74601-2018
Phone 580-762-1911 · Fax 580-762-0887
Mailing address
4196 Highway 62 412 Ste AHardy, AR 72542-8002
Authorized official
Monya York
Controller
8708561202
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Rural Health Clinic/Center providers in Ponca City, OK
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