Provider Demographics
NPI:1972509701
Name:GIBSON COMMUNITY HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:GIBSON COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ERTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-784-2601
Mailing Address - Street 1:912 W SEMINARY AVE
Mailing Address - Street 2:
Mailing Address - City:ONARGA
Mailing Address - State:IL
Mailing Address - Zip Code:60955-1401
Mailing Address - Country:US
Mailing Address - Phone:815-268-4840
Mailing Address - Fax:815-268-4845
Practice Address - Street 1:912 W SEMINARY AVE
Practice Address - Street 2:
Practice Address - City:ONARGA
Practice Address - State:IL
Practice Address - Zip Code:60955-1401
Practice Address - Country:US
Practice Address - Phone:815-268-4840
Practice Address - Fax:815-268-4845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIBSON COMMUNITY HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X, 261QR1300X
IL007261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========007MedicaidTHE ONARGA CLINIC
IL=========007Medicaid
IL=========007MedicaidTHE ONARGA CLINIC