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Gibson Community Hospital Association

Organization Active NPI Community/Retail Pharmacy · Gibson City, IL

NPI 1477570166 · NPPES record last updated Jul 17, 2023

Key facts

NPI
1477570166
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
054015227 (IL)
Legal business name
GIBSON COMMUNITY HOSPITAL ASSOCIATION
Practice address
104 N. Sangamon Ave
Gibson City, IL 60936-1343
Phone
(217) 784-8545
Fax
(217) 784-8039
NPI assigned
Jul 17, 2006
Organization subpart
Yes
Parent organization (as reported)
GIBSON COMMUNITY HOSPITAL ASSOCIATION

Authorized official

Name
Mr. Matthew Ertel
Title
Chief Financial Officer
Phone
(217) 784-4251

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

Practitioners 159

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 159

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20210325002397 IL Part B Supplier - Pharmacy 5092703124 Practice locations: Gibson City, IL

National Provider Directory

Tax ID family
The Paxton Clinic (42 organizations share this tax ID)
Part of
The Paxton Clinic

Locations

104 N Sangamon Ave
Gibson City, IL 60936
Phone (217) 784-8545

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 054015227 IL Yes

Addresses

Primary practice location

104 N. Sangamon Ave
Gibson City, IL 60936-1343

Mailing address

1120 N. Melvin St
Gibson City, IL 60936-1477
Phone (217) 784-8545

Other identifiers

IdentifierTypeStateIssuer
1422853OtherILNCPDP #
550868762001MedicaidIL

Other names

  • Gibson Family Pharmacy, A Member of the Medicine Shoppe Family Doing business as

Other providers in Gibson City, IL

All providers in Gibson City, IL · Community/Retail Pharmacy in Illinois

Sources for this page

Verify at the official NPI Registry.