Organization
FORREST FAMILY PRACTICE CENTER LLC
Active
Parent organization
GIBSON COMMUNITY HOSPITAL ASSOCIATION
Other names
Forrest Family Practice LLc
Organization subpart
Yes
Provider details
NPI number
Legal business name
GIBSON COMMUNITY HOSPITAL ASSOCIATION
Authorized official
DR. BENJAMIN E BREWER MD (OWNER)
(815) 657-8707
Entity
Organization
Contact information
Practice address
122 E WABASH AVE, FORREST, IL 61741
(815) 657-8707
(815) 657-8717
Mailing address
122 E WABASH AVE, P O BOX 58, FORREST, IL 61741
(815) 657-8707
(815) 657-8717
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
364468162001
—
IL
Enumeration date
01/23/2008
Last updated
07/02/2009
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