Gibson Community Hospital Association
Organization Active NPI General Practice Physician · Fisher, IL
NPI 1508214404 · NPPES record last updated Jun 1, 2016
Key facts
- NPI
- 1508214404
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- Legal business name
- GIBSON COMMUNITY HOSPITAL ASSOCIATION
- Practice address
- 104 S 3Rd St
Fisher, IL 61843-9549 - Phone
- (217) 897-1692
- Fax
- (217) 897-6027
- NPI assigned
- Jun 1, 2016
- Organization subpart
- No
Authorized official
- Name
- Mr. Bryan Coffey
- Title
- Chief Financial Officer
- Phone
- (217) 784-2601
Other NPIs on the same Medicare enrollment 38
Corporate family (same tax ID) 41
Practitioners 4
-
Surekha Boddipalli, M.D.
-
Christina M Toohill, OCCUP THERAPIST
-
Wahid Tazudeen, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040505001293 | IL | Part B Supplier - Clinic/Group Practice | 5092703124 |
Receives reassigned benefits from 201 practitioners 38 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Watseka, IL; Urbana, IL; Paxton, IL; Fairbury, IL; Onarga, IL; Mahomet, IL; Hoopeston, IL; Gibson City, IL… |
National Provider Directory
- Tax ID family
- The Paxton Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | Yes |
Addresses
Primary practice location
104 S 3Rd St
Fisher, IL 61843-9549
Mailing address
104 S 3Rd St
Fisher, IL 61843-9549
Phone (217) 897-1692
Other names
- Family Healthcare of Fisher
Other providers in Fisher, IL
- Gregory Lee Beesley
- County of Champaign Community Unit School District No 1
- Norman Elwood
- Fisher Chiropractic & Wellness Center, LLC
- Rebecca Malina
- Lisa Obryan
- Jayne Ochsner-Ndessokia
- Lindsay Kay Roseman
- Jordan L Scott
All providers in Fisher, IL · General Practice Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.