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General NPI Number Information
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NPI Number | 1457616229
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Entity Type | Organization
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Legal Business Name | GIBSON COMMUNITY HOSPITAL ASSOCIATION
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 1015 S MERCER AVE
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City | BLOOMINGTON
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State | IL
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Zip | 61701-7107
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Country | US
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Telephone | 217-784-4251
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 N MELVIN ST
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City | GIBSON CITY
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State | IL
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Zip | 60936-1477
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MATTHEW ERTEL
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Credential |
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Telephone | 217-784-2601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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