Healthcare Provider Details

I. General information

NPI: 1043737448
Provider Name (Legal Business Name): BETHANY MORGAN GEBUR DMSC, MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY MORGAN HENDERSON

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 W WEAVER RD
FORSYTH IL
62535-9762
US

IV. Provider business mailing address

609 E VOREY ST
HEYWORTH IL
61745-9619
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-5220
  • Fax: 217-876-8949
Mailing address:
  • Phone: 254-258-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085006286
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.006286
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: