Provider Demographics
NPI:1356779417
Name:GIBSON COMMUNITY HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:GIBSON COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:217-784-2600
Mailing Address - Street 1:106 E. STATE ST
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:IL
Mailing Address - Zip Code:61865
Mailing Address - Country:US
Mailing Address - Phone:217-987-6300
Mailing Address - Fax:217-987-6333
Practice Address - Street 1:106 E. STATE ST
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:IL
Practice Address - Zip Code:61865
Practice Address - Country:US
Practice Address - Phone:217-987-6300
Practice Address - Fax:217-987-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000836261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health