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Organization
GIBSON COMMUNITY HOSPITAL ASSOCIATION
Active
Organization
GIBSON COMMUNITY HOSPITAL ASSOCIATION
Active
Other names
Family Healthcare of Fairbury
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW ERTEL (CFO)
(217) 784-2600
Entity
Organization
Contact information
Practice address
221 WAL CREST DR, FAIRBURY, IL 61739-8998
(815) 692-1150
(815) 692-1153
Mailing address
221 WAL CREST DR, FAIRBURY, IL 61739-8998
(815) 692-1150
(815) 692-1153
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0000836
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
825130
MEDICARE PTAN
IL
Enumeration date
10/07/2011
Last updated
11/08/2023
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