# GIBSON COMMUNITY HOSPITAL ASSOCIATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GIBSON COMMUNITY HOSPITAL ASSOCIATION
- **Other names:** Prairie Family Medicine and Obstetrics
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1063462976
- **Legal business name:** GIBSON COMMUNITY HOSPITAL ASSOCIATION
- **Authorized official:** MATTHEW ERTEL (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (217) 784-2601

## Contact information

- **Practice address:** 122 E WABASH AVE, FORREST, IL 61741-9369
- **Practice address phone:** (815) 657-8707
- **Practice address fax:** (815) 657-8717
- **Mailing address:** 122 E WABASH AVE, FORREST, IL 61741-9369
- **Mailing address phone:** (815) 657-8707
- **Mailing address fax:** (815) 657-8717

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/11/2006
- **Last updated:** 02/04/2022