Healthcare Provider Details

I. General information

NPI: 1477276301
Provider Name (Legal Business Name): DECATUR MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N EDWARD ST
DECATUR IL
62526-4192
US

IV. Provider business mailing address

2300 N EDWARDS ST MEDICAL STAFF OFFICE
DECATUR IL
62526
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-8121
  • Fax:
Mailing address:
  • Phone: 217-876-2857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JUDI L HARLAN
Title or Position: NETWORK DEVELOPMENT AND PARTNERSHIP
Credential:
Phone: 217-588-2882