Provider Demographics
NPI:1699883405
Name:GIBSON CITY MELVIN SIBLEY #5
Entity type:Organization
Organization Name:GIBSON CITY MELVIN SIBLEY #5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:AUBRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-784-8296
Mailing Address - Street 1:217 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-1072
Mailing Address - Country:US
Mailing Address - Phone:217-784-8296
Mailing Address - Fax:217-784-8558
Practice Address - Street 1:217 E 17TH ST
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936-1072
Practice Address - Country:US
Practice Address - Phone:217-784-8296
Practice Address - Fax:217-784-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid