Healthcare Provider Details

I. General information

NPI: 1568453462
Provider Name (Legal Business Name): GIBSON GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 SHERMAN DR
PRINCETON IN
47670
US

IV. Provider business mailing address

1808 SHERMAN DR
PRINCETON IN
47670-1043
US

V. Phone/Fax

Practice location:
  • Phone: 812-385-9222
  • Fax: 812-385-9323
Mailing address:
  • Phone: 812-385-9288
  • Fax: 812-385-9423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number05-000036-1
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number17-00036-1
License Number State

VIII. Authorized Official

Name: LOIS MORGEN
Title or Position: CNO
Credential: CNO
Phone: 812-385-9237