GIBSON COMMUNITY HOSPITAL ANNEX (NPI# 1346405941) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346405941 |
| Entity Type | Organization |
| Organization Name | GIBSON COMMUNITY HOSPITAL ANNEX |
| Practice Address |
1120 N Melvin St Gibson City IL 60936-1477 |
| Practice Telephone | 2177842600 |
| Mailing Telephone | 2177842600 |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2010-03-11 |
| Authorized Official Name | ROB SCHMITT (CEO) |
| Authorized Official Telephone | 2177842611 |
| Is Organization Subpart | Y |
| Parent Organization Name | GIBSON COMMUNITY HOSPITAL ASSOCIATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 313M00000X | Nursing Facility/Intermediate Care Facility | 0005868 | IL | Nursing & Custodial Care Facilities |
| Street Address |
1120 N MELVIN ST |
| City | GIBSON CITY |
| State | IL |
| Zip Code | 60936-1477 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093705501 | Serge Peter Marinkovic | Surgery | 1120 N Melvin St, Gibson City, IL 60936-1477 | 2005-10-26 |
| 1346883808 | Sheree Stachura | Nurse Practitioner | 1120 N Melvin St, Gibson City, IL 60936-1477 | 2019-10-28 |
| 1063054203 | Natalie Weaver | Nurse Practitioner | 1120 N Melvin St, Gibson City, IL 60936-1477 | 2019-10-09 |
| 1649757386 | Omar Ahmad Ali | Dentist | 1120 N Melvin St, Gibson City, IL 60936-1477 | 2018-07-25 |
| 1306330477 | Gibson Community Hospital Association | Dentist | 1120 N Melvin St, Gibson City, IL 60936-1477 | 2018-06-21 |
| 1235667593 | Gibson Community Hospital Association | Family Medicine | 1120 N Melvin St, Gibson City, IL 60936-1477 | 2017-05-31 |
| 1073065140 | Jodie Vaughn | Nurse Practitioner | 1120 N Melvin St, Gibson City, IL 60936-1477 | 2016-10-25 |
| 1982029856 | Jennifer Casey | Clinical Nurse Specialist | 1120 N Melvin St, Gibson City, IL 60936-1477 | 2014-02-28 |
| 1457616229 | Gibson Community Hospital Association | Anesthesiology | 1120 N Melvin St, Gibson City, IL 60936-1477 | 2012-07-09 |
| 1235438417 | Christine Grundeman | Psychiatry & Neurology | 1120 N Melvin St, Gibson City, IL 60936-1477 | 2011-03-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073738738 | Carrie Ann Lithgow | Physical Therapist | 109 N. Sangamon Ave, Gibson City, IL 60936 | 2007-04-16 |
| 1144359001 | Kerrie Ann Patrick | Registered Nurse | 222 N Sangamon, Gibson City, IL 60936 | 2007-03-05 |
| 1578612800 | Donna J Boundy | Dentist | 627 E 8th St, Gibson City, IL 60936 | 2007-01-09 |
| 1093878241 | Drew Curtis Duquette | Chiropractor | 523 and One Half South Sangamon Ave, Gibson City, IL 60936 | 2006-12-19 |
| 1386727642 | Amnuay Sethakorn | Family Medicine | 4 Doctors Park, Gibson City, IL 60936 | 2006-10-23 |
| 1689687295 | Alexander V Grandt | Nurse Practitioner | 1120 N Melvin, Gibson Area Hospital & Health Services, Gibson, IL 60936 | 2006-08-14 |
| 1811125784 | Gibson Community Hospital Association | Surgery | 1 Doctors Park, Gibson City, IL 60936 | 2009-06-30 |
| 1295991701 | Trilok Shah | Psychiatry & Neurology | 4 Doctors Park, Gibson City, IL 60936 | 2008-08-04 |
| 1013050046 | Rebecca Anne Wildermuth | Specialist/Technologist | 10 Doctors Park, Gibson City, IL 60936 | 2007-02-15 |
| 1245312602 | Ginny E Pulley | Licensed Practical Nurse | 222 N Sangamon Ave, Gibson City, IL 60936 | 2006-10-19 |
| Find all providers in zip 60936 | ||||
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114935681 | Gibson Community Hospital Association | Nursing Facility/Intermediate Care Facility | 1120 N Melvin St, Gibson City, IL 60936-1477 | 2006-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386094068 | Icg Home Health | Nursing Facility/Intermediate Care Facility | 4508 Camden Ct, Richton Park, IL 60471-1147 | 2016-06-14 |
| 1871999078 | Midwest Health Operations LLC | Nursing Facility/Intermediate Care Facility | 3601 16th Ave, Sterling, IL 61081-4059 | 2014-11-15 |
| 1437410891 | Mado Healthcare | Nursing Facility/Intermediate Care Facility | 1541 North Wells, Chicago, IL 60610-1307 | 2012-06-01 |
| 1134405392 | Faith Community Health Services, Inc | Nursing Facility/Intermediate Care Facility | 4449 177th St, Country Club Hills, IL 60478-4705 | 2011-11-01 |
| 1215188487 | Petersen Health Care, Inc | Nursing Facility/Intermediate Care Facility | 144 Jounior Ave., Kewanee, IL 61443 | 2008-10-07 |
| 1699936054 | Pinckneyville Healthcare Center | Nursing Facility/Intermediate Care Facility | 708 Virginia Ct, Pinckneyville, IL 62274-1538 | 2008-06-18 |
| 1184894412 | Parents and Friends of The Slc-home 1 | Nursing Facility/Intermediate Care Facility | 3 Gundlach Pl, Swansea, IL 62226-4227 | 2008-03-03 |
| 1740463074 | St. Joseph's Home of Springfield | Nursing Facility/Intermediate Care Facility | 3306 S 6th Street Rd, Springfield, IL 62703-4735 | 2007-12-10 |
| 1821283573 | Royal Living Center Inc | Nursing Facility/Intermediate Care Facility | 200 South 9th Street, New Baden, IL 62265 | 2007-09-06 |
| 1235323841 | Parents and Friends of Slc | Nursing Facility/Intermediate Care Facility | 1450 Caseyville Ave, Swansea, IL 62226-4517 | 2007-08-28 |
| Find all providers with the same taxonomy | ||||
| City | GIBSON CITY |
| Zip Code | 60936 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.