Basic Information
| Provider Information | |||||||||
| NPI: | 1730587809 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GIBSON GENERAL HOSPITAL INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GIBSON GENERAL HOSPITAL FAMILY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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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: | 4840 S MAPLE TREE DR | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476709277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123874444 | ||||||||
| FaxNumber: | 8123874445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2014 | ||||||||
| LastUpdateDate: | 12/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | SCHUSTER | ||||||||
| AuthorizedOfficialFirstName: | EMMETT | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 8123859221 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 14-005019-1 | IN | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.