Healthcare Provider Details

I. General information

NPI: 1306854179
Provider Name (Legal Business Name): GIBSON AREA HOSPITAL AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N MELVIN ST
GIBSON CITY IL
60936-1477
US

IV. Provider business mailing address

1120 N MELVIN ST
GIBSON CITY IL
60936-1477
US

V. Phone/Fax

Practice location:
  • Phone: 217-784-2566
  • Fax: 217-784-2230
Mailing address:
  • Phone: 217-784-2566
  • Fax: 217-784-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0006708
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateIL

VIII. Authorized Official

Name: ROB SCHMITT
Title or Position: CEO
Credential:
Phone: 217-784-2611