Provider Demographics
NPI:1053756643
Name:VANBIBER MEDICAL CLINIC
Entity type:Organization
Organization Name:VANBIBER MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:VANBIBER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:713-557-0469
Mailing Address - Street 1:2128 SPEARS
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067
Mailing Address - Country:US
Mailing Address - Phone:713-557-0469
Mailing Address - Fax:
Practice Address - Street 1:2128 SPEARS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067
Practice Address - Country:US
Practice Address - Phone:713-557-0469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5728174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty