# GIBSON CITY CLINIC SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386903946
- **Authorized official:** DAVID HAGAN M.D. (PRESIDENT)
- **Authorized official phone:** (217) 784-8148

## Contact information

- **Practice address:** 222 N SANGAMON AVE, GIBSON CITY, IL 60936-1345
- **Practice address phone:** (217) 784-8148
- **Practice address fax:** (217) 784-8160
- **Mailing address:** 222 N SANGAMON AVE, GIBSON CITY, IL 60936-1345
- **Mailing address phone:** (217) 784-8148
- **Mailing address fax:** (217) 784-8160

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 036-066538 | IL | Yes |

## Other

- **Enumeration date:** 05/16/2012
- **Last updated:** 05/16/2012