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General NPI Number Information
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NPI Number | 1548544679
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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 | 10/07/2011
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 221 WAL CREST DR
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City | FAIRBURY
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State | IL
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Zip | 61739-8998
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Country | US
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Telephone | 815-692-1150
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Fax | 815-692-1153
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Provider Business Mailing Address
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Address Line | 221 WAL CREST DR
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City | FAIRBURY
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State | IL
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Zip | 61739-8998
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Country | US
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Telephone | 815-692-1150
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Fax | 815-692-1153
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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 | 217-784-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0000836
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License Number State | IL
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