NPIMap

Organization Active NPI

Gibson City Clinic SC

  • Clinic/Center
  • Gibson City, IL
National Provider Identifier
1386903946
Registry record updated May 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
036-066538 Issued in IL
Legal business name
GIBSON CITY CLINIC SC
Practice address
222 N Sangamon Ave
Gibson City, IL 60936-1345
Phone
(217) 784-8148
Fax
(217) 784-8160
NPI assigned
May 16, 2012
Last updated
May 16, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Hagan, M.D.NPI 1467433557
Title
President
Phone
(217) 784-8148

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 036-066538 IL Primary

Addresses

Primary practice location

222 N Sangamon Ave
Gibson City, IL 60936-1345

Mailing address

222 N Sangamon Ave
Gibson City, IL 60936-1345
Phone (217) 784-8148

National Provider Directory

National Provider Directory

Locations

222 N Sangamon Ave
Gibson City, IL 60936
Phone (217) 748-8148

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337126400000",
    "number": "1386903946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 N SANGAMON AVE",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609361345",
            "telephone_number": "217-784-8148",
            "fax_number": "217-784-8160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 N SANGAMON AVE",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609361345",
            "telephone_number": "217-784-8148",
            "fax_number": "217-784-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIBSON CITY CLINIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-16",
        "last_updated": "2012-05-16",
        "status": "A",
        "authorized_official_last_name": "HAGAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-784-8148",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "036-066538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gibson City, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.