Provider Demographics
NPI:1932225372
Name:TULIP TREE HEALTH SERVICES OF GIBSON COUNTY, INC.
Entity Type:Organization
Organization Name:TULIP TREE HEALTH SERVICES OF GIBSON COUNTY, INC.
Other - Org Name:TULIP TREE FAMILY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GEORGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-753-1039
Mailing Address - Street 1:108 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-1540
Mailing Address - Country:US
Mailing Address - Phone:812-753-1039
Mailing Address - Fax:812-753-1122
Practice Address - Street 1:123 N MCCREARY ST
Practice Address - Street 2:
Practice Address - City:FORT BRANCH
Practice Address - State:IN
Practice Address - Zip Code:47648
Practice Address - Country:US
Practice Address - Phone:812-753-1039
Practice Address - Fax:812-753-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X, 261Q00000X, 261QF0400X
IN02000610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200248220AMedicaid
IN300039487AMedicaid