Provider Demographics
NPI:1972984995
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 COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:CCO
Authorized Official - Phone:217-784-2286
Mailing Address - Street 1:8 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-2000
Mailing Address - Country:US
Mailing Address - Phone:217-784-8580
Mailing Address - Fax:217-784-8586
Practice Address - Street 1:8 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936-2000
Practice Address - Country:US
Practice Address - Phone:217-784-8580
Practice Address - Fax:217-784-8586
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIBSON COMMUNITY HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000836261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health