1881676005 NPI number — GIBSON COMMUNITY HOSPITAL ASSOCIATION

Table of content: DR. TIFFANY LI WEN CHING M.D (NPI 1912297656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881676005 NPI number — GIBSON COMMUNITY HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GIBSON COMMUNITY HOSPITAL ASSOCIATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY HEALTHCARE OF HOOPESTON
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881676005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 S DIXIE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOOPESTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60942-1904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-283-5530
Provider Business Mailing Address Fax Number:
217-283-6437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 S DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOOPESTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60942-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-283-5530
Provider Business Practice Location Address Fax Number:
217-283-6437
Provider Enumeration Date:
11/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ERTEL
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
217-784-2601

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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