Basic Information
| Provider Information | |||||||||
| NPI: | 1558346007 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GIBSON GENERAL HOSPITAL INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1808 SHERMAN DR | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476701043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123853401 | ||||||||
| FaxNumber: | 8123859307 | ||||||||
| Practice Location | |||||||||
| Address1: | 1808 SHERMAN DR | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476701043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123853401 | ||||||||
| FaxNumber: | 8123859307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 06/02/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MORGAN | ||||||||
| AuthorizedOfficialFirstName: | LOIS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT AND CNO | ||||||||
| AuthorizedOfficialTelephone: | 8123859237 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 06/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 100269650 | 05 | IN | MEDICAID | 200713830 | 01 | IN | FIRSTSTEP | OTHER | 100269630 | 05 | IN | MEDICAID | 000000107485 | 01 | IN | ANTHEM BLUE CROSS | OTHER |