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GIBSON COMMUNITY HOSPITAL ASSOCIATION NPI 1548544679


NPI Information

NPI: 1548544679
Provider Name: GIBSON COMMUNITY HOSPITAL ASSOCIATION

Doing Business As: FAMILY HEALTHCARE OF FAIRBURY

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 14D2031759

Address:
221 WAL CREST DR
FAIRBURY, IL
ZIP 61739
Phone: (815) 692-1150
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GIBSON COMMUNITY HOSPITAL ASSOCIATION is a family medicine in Fairbury, IL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. GIBSON COMMUNITY HOSPITAL ASSOCIATION NPI is 1548544679. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Family Healthcare Of Fairbury.

The provider's business location address is:

221 WAL CREST DR
FAIRBURY, IL
ZIP 61739-998
Phone: (815) 692-1150
Fax: (815) 692-1153

The provider's authorized official is Matthew Ertel .
The authorized official title is Cfo and has the following contact phone number (217) 784-2600.

The CLIA number assigned to this NPI record is 14D2031759 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 10/7/2011 and was last updated on 11/8/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily Medicine0000836ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1825130OTHERILLINOISMEDICARE PTAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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