Organization
SOUTH GIBSON MEDICAL CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. QUINTEN B EMERSON M.D. (PROVIDER/OWNER)
(812) 753-4181
Entity
Organization
Contact information
Practice address
7861 S PROFESSIONAL DR, FORT BRANCH, IN 47648-8405
(812) 753-4181
(812) 753-4399
Mailing address
PO BOX 185, FORT BRANCH, IN 47648-0185
(812) 753-4181
(812) 753-4399
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01027038
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100122120
—
IN
Enumeration date
05/16/2008
Last updated
07/30/2008
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