Provider Demographics
NPI:1215095344
Name:GIBSON COUNTY AUDITOR
Entity type:Organization
Organization Name:GIBSON COUNTY AUDITOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TULEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:812-385-3831
Mailing Address - Street 1:203 S PRINCE ST STE A
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-2151
Mailing Address - Country:US
Mailing Address - Phone:812-385-3831
Mailing Address - Fax:812-386-8027
Practice Address - Street 1:203 S PRINCE ST STE A
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-2151
Practice Address - Country:US
Practice Address - Phone:812-385-3831
Practice Address - Fax:812-386-8027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200317570Medicaid