Organization
GIBSON COMMUNITY HOSPTIAL ASSN
Active
Parent organization
GIBSON COMMUNITY HOSPITAL ASSN
Other names
Prairie Family Medicine and Obstetrics
Organization subpart
Yes
Provider details
NPI number
Legal business name
GIBSON COMMUNITY HOSPITAL ASSN
Authorized official
DAWN R KESTNER CPC (OFFICE MANAGER)
(815) 657-8707
Entity
Organization
Contact information
Practice address
122 E WABASH AVE, FORREST, IL 61741-9369
(815) 657-8707
(815) 657-8717
Mailing address
122 E WABASH AVE, P O BOX 58, FORREST, IL 61741-9369
(815) 657-8707
(815) 657-8717
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085005214
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063462976
—
IL
Enumeration date
09/18/2014
Last updated
09/18/2014
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