Healthcare Provider Details

I. General information

NPI: 1023597713
Provider Name (Legal Business Name): GIBSON GENERAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N MAIN ST
PRINCETON IN
47670
US

IV. Provider business mailing address

PO BOX 1197
EVANSVILLE IN
47706-1197
US

V. Phone/Fax

Practice location:
  • Phone: 812-386-7522
  • Fax: 812-386-1097
Mailing address:
  • Phone: 812-386-7522
  • Fax: 812-386-1097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LOIS MORGAN
Title or Position: VICE-PRESIDENT & CNO
Credential:
Phone: 812-385-9237