Provider Demographics
NPI:1578611166
Name:GIBSON MOBILITY AND TRANSPORTATION,INC.
Entity Type:Organization
Organization Name:GIBSON MOBILITY AND TRANSPORTATION,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-493-8070
Mailing Address - Street 1:4312 HICKORY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46797-9584
Mailing Address - Country:US
Mailing Address - Phone:260-493-8070
Mailing Address - Fax:260-493-8072
Practice Address - Street 1:4312 HICKORY RIDGE DR
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:IN
Practice Address - Zip Code:46797-9584
Practice Address - Country:US
Practice Address - Phone:260-493-8070
Practice Address - Fax:260-493-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INUSDOT 1136909343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)