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NPI Code Detail

MEDICARE: GIBSON HEALTH SERVICES, INC.

MEDICARE: GIBSON HEALTH SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency1003698IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19857OTHERILBCBS PROVIDER NUMBER

General Provider Information

NPI Number : 1205970712
Entity Type Code : Organization
Provider Name (Legal Business Name) : GIBSON HEALTH SERVICES, INC.
Provider Business Mailing Address
First Line : 1468 STATE ST
Second Line : P. O. BOX 368
City : EAST SAINT LOUIS
State : IL
Zip : 62205-2010
Country : US
Telephone Number : 618-274-6026
Fax Number : 618-274-4314
Provider Business Practice Location Address
First Line : 1468 STATE ST
Second Line : SUITE 100
City : EAST SAINT LOUIS
State : IL
Zip : 62205-2010
Country : US
Telephone Number : 618-274-6026
Fax Number : 618-274-4314
Authorized Official
Title or Position : PRESIDENT & CEO
Name : MS. PATRICIA A GIBSON
Credential : RN, BSN, MPH
Telephone Number : 618-274-6026
Provider Enumeration Date : 02/16/2007
Last Update Date : 03/04/2010

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