Healthcare Provider Details

I. General information

NPI: 1164477725
Provider Name (Legal Business Name): DECATUR MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N EDWARD ST GSBLL
DECATUR IL
62526-4163
US

IV. Provider business mailing address

2300 N EDWARD ST
DECATUR IL
62526-4163
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-2868
  • Fax: 217-876-2874
Mailing address:
  • Phone: 217-876-2857
  • Fax: 217-876-6485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DREW EARLY
Title or Position: CEO
Credential:
Phone: 217-876-2114