Provider Demographics
NPI:1881074789
Name:GIBSON, THOMAS MITCHELL (HEALTH AID)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MITCHELL
Last Name:GIBSON
Suffix:
Gender:M
Credentials:HEALTH AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 C STREET, EASTERN ALEUTIAN TRIBES
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:907-277-1440
Mailing Address - Fax:907-277-1446
Practice Address - Street 1:40 MAINSTREET
Practice Address - Street 2:PAUL MARTIN GUNDERSEN MEMORIAL CLINIC
Practice Address - City:NELSON LAGOON
Practice Address - State:AK
Practice Address - Zip Code:99751
Practice Address - Country:US
Practice Address - Phone:907-989-2202
Practice Address - Fax:907-989-2245
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK06-891-IV172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK06-891-IVOtherALASKA COMMUNITY HEALTH AID CERTIFICATION