South Gibson Medical Clinic Inc.
Organization Active NPI Family Medicine Physician · Fort Branch, IN
NPI 1659538841 · NPPES record last updated Jul 30, 2008
Key facts
- NPI
- 1659538841
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 01027038 (IN)
- Legal business name
- SOUTH GIBSON MEDICAL CLINIC INC.
- Practice address
- 7861 S Professional Dr
Fort Branch, IN 47648-8405 - Phone
- (812) 753-4181
- Fax
- (812) 753-4399
- NPI assigned
- May 16, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Quinten B Emerson, M.D.
- Title
- Provider/Owner
- Phone
- (812) 753-4181
Practitioners 1
-
Quentin B Emerson, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080807000141 | IN | Part B Supplier - Clinic/Group Practice | 6002980133 |
Receives reassigned benefits from 1 practitioner Practice locations: Ft Branch, IN |
National Provider Directory
Locations
7861 S Professional Dr
Fort Branch, IN 47648
Phone (812) 753-4181
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 01027038 | IN | Yes |
Addresses
Primary practice location
7861 S Professional Dr
Fort Branch, IN 47648-8405
Mailing address
PO Box 185
Fort Branch, IN 47648-0185
Phone (812) 753-4181
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100122120 | Medicaid | IN |
Other providers in Fort Branch, IN
- Marilyn Joyce Ostendorf
- Whitney L Pflanz
- Herman L Reid III
- Ronald Rexing
- Vinie May Scamman
- South Gibson School Corp
- Sue A Steinmetz
- Demetra G Tolley
- Tulip Tree Health Services of Gibson County, Inc.
- Terry Hubert Unfried
All providers in Fort Branch, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2008. 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.