Provider Demographics
NPI:1568453462
Name:GIBSON GENERAL HOSPITAL
Entity Type:Organization
Organization Name:GIBSON GENERAL HOSPITAL
Other - Org Name:GIBSON GENERAL HOSPITAL - SNF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CNO
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGEN
Authorized Official - Suffix:
Authorized Official - Credentials:CNO
Authorized Official - Phone:812-385-9237
Mailing Address - Street 1:1808 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-1043
Mailing Address - Country:US
Mailing Address - Phone:812-385-9288
Mailing Address - Fax:812-385-9423
Practice Address - Street 1:1808 SHERMAN DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670
Practice Address - Country:US
Practice Address - Phone:812-385-9222
Practice Address - Fax:812-385-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-000036-1313M00000X
17-00036-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ 000036OtherFACILITY ID FOR MDS TRANS
IN100269640Medicaid
IN100269640Medicaid