Provider Demographics
NPI:1205970712
Name:GIBSON HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:GIBSON HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MPH
Authorized Official - Phone:618-274-6026
Mailing Address - Street 1:1468 STATE ST
Mailing Address - Street 2:P. O. BOX 368
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62205-2010
Mailing Address - Country:US
Mailing Address - Phone:618-274-6026
Mailing Address - Fax:618-274-4314
Practice Address - Street 1:1468 STATE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62205-2010
Practice Address - Country:US
Practice Address - Phone:618-274-6026
Practice Address - Fax:618-274-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1003698251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9857OtherBCBS PROVIDER NUMBER
IL9857OtherBCBS PROVIDER NUMBER
IL=========001Medicaid