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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