JACK L GIBBS (NPI# 1407964612) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407964612 |
| Entity Type | Individual |
| Full Name | JACK L GIBBS |
| Credential | MD |
| Practice Address |
175 S Main St Canton IL 61520-2670 |
| Practice Telephone | 3096470201 |
| Practice Fax Number | 3096495302 |
| Mailing Telephone | 3096470201 |
| Mailing Fax Number | 3096495302 |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2007-12-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | JOHN DEERE | IL0123 | 01 |
| IL | RR MEDICARE GROUP# | CG5172 | 01 |
| IL | BLACK LUNG | 200397 | 01 |
| IL | HEALTH ALLIANCE | 014153 | 01 |
| IL | OSF HEALTHPLANS | 032923 | 01 |
| IL | NPI CLINIC NUMBER | 1942315197 | 01 |
| IL | UMWA | 0062839 | 01 |
| IL | BCBS | 02922981 | 01 |
| IL | HEALTH LINK | 179546 | 01 |
| Street Address |
175 S MAIN ST |
| City | CANTON |
| State | IL |
| Zip Code | 61520-2670 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992771216 | Fordyce Edward Stivers | Otolaryngology | 175 S Main St, Canton, IL 61520-2670 | 2006-02-27 |
| 1437518370 | Andrea Lee White | Social Worker | 175 S Main St, Canton, IL 61520-2670 | 2016-02-21 |
| 1427334879 | B. Wright Back Chiropractic, Inc. | Chiropractor | 175 S Main St, Canton, IL 61520-2670 | 2011-10-31 |
| 1235425661 | Brandon Michael Wright | Chiropractor | 175 S Main St, Canton, IL 61520-2670 | 2011-06-23 |
| 1235458639 | Michael Reuss Blessman | Pharmacist | 175 S Main St, Canton, IL 61520-2670 | 2010-05-25 |
| 1689704660 | Sandi Greene Deford | Audiologist | 175 S Main St, Canton, IL 61520-2670 | 2007-03-07 |
| 1881730331 | Erin P. O'brien | Physician Assistant | 175 S Main St, Canton, IL 61520-2670 | 2007-01-30 |
| 1033263116 | Blessman Pharmacy | Pharmacist | 175 S Main St, Suite 1, Canton, IL 61520-2670 | 2007-01-23 |
| 1356450142 | Abby A Putnam | Nurse Practitioner | 175 S Main St, Canton, IL 61520-2670 | 2006-08-29 |
| 1942315197 | Graham Services Corporation | Internal Medicine | 175 S Main St, Canton, IL 61520-2670 | 2006-08-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497978480 | Walton Cs-xi P.C. | Chiropractor | 410 E. Elm Street, Canton, IL 61520 | 2007-04-10 |
| 1811912918 | Jennifer Christine Daniel-price | Chiropractor | 410 E Elm Street, Canton, IL 61520 | 2006-07-12 |
| 1245216241 | Fulton County Health Department | Clinic/Center | 700 East Oak Street, Canton, IL 61520 | 2005-12-21 |
| 1124482252 | Ryan Deushane | Nurse Anesthetist, Certified Registered | 210 W Walnut St, Canton, IL 61520 | 2016-04-05 |
| 1750749826 | Shawn Michael Wynn | Nurse Anesthetist, Certified Registered | 210 W Walnut St, Canton, IL 61520 | 2016-02-04 |
| 1417312232 | Danielle Marianna Sausaman | Dietitian, Registered | 210 W Walnut St, Graham Hospital Food and Nutrition Services, Canton, IL 61520 | 2015-12-21 |
| 1740533835 | Abby L. Sherwood | Chiropractor | 410 E Elm Street, Canton, IL 61520 | 2012-10-26 |
| 1417261041 | Erin Kathleen Buckley | Obstetrics & Gynecology | 180 S Main St, Canton, IL 61520 | 2010-08-06 |
| 1619375532 | Brittany Nicole Miller | Nurse Practitioner | 1300 E Locust St, Canton, IL 61520-0008 | 2014-12-09 |
| 1437197845 | Heartland of Canton Il LLC | Clinic/Center | 2081 N Main St, Canton, IL 61520-1032 | 2006-06-04 |
| Find all providers in zip 61520 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619210481 | James Robert Cardella | Surgery | 1330 Mercy Dr Nw Ste 418, Canton, OH 44708-2625 | 2013-03-31 |
| 1417213893 | Kathryn Parker | Surgery | 470 Northside Cherokee Blvd Ste 230, Canton, GA 30115-8015 | 2012-04-10 |
| 1356570659 | Arcangelo V Mariano | Surgery | 10 Powderhill Rd, Canton, MA 02021-2101 | 2009-07-08 |
| 1053557223 | Roc & Associates M. D., P. C. | Surgery | 8554 N Canton Center Rd, Canton, MI 48187-1310 | 2008-12-18 |
| 1881802650 | Melvin Richard Stjernholm | Surgery | 2600 Tuscarawas St W Ste 620, Canton, OH 44708-4676 | 2007-05-17 |
| 1053421156 | James Scott Young | Surgery | 2600 6 St Sw, Aultman Hospital, Canton, OH 44710 | 2006-08-30 |
| 1174558209 | William Mark Nannery | Surgery | 490 Chapman St, Canton, MA 02021-2039 | 2006-07-11 |
| 1639137581 | Gilbert Matas Roc | Surgery | 8554 Canton Center Rd, Canton, MI 48187-1310 | 2006-05-02 |
| 1235190554 | Bireswar Patnaik | Surgery | 4190 Holiday St Nw, Canton, OH 44718-2532 | 2006-03-28 |
| 1699160143 | Joseph W Gunter IIi Md Pllc | Surgery | 156 River Oaks Dr, Suite B, Canton, MS 39046-5376 | 2015-04-01 |
| Find all providers in CANTON | ||||
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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.