Provider Demographics
NPI:1255541736
Name:GIBSON GENERAL HOSPITAL SWING BED
Entity type:Organization
Organization Name:GIBSON GENERAL HOSPITAL SWING BED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHOULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-385-9201
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:812-385-9201
Mailing Address - Fax:812-385-9307
Practice Address - Street 1:1808 SHERMAN DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1043
Practice Address - Country:US
Practice Address - Phone:812-385-9201
Practice Address - Fax:812-385-9307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIBSON GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-23
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15Z319Medicare Oscar/Certification