Healthcare Provider Details

I. General information

NPI: 1922645910
Provider Name (Legal Business Name): WABASH GENERAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 CHESTNUT ST
MOUNT CARMEL IL
62863-1212
US

IV. Provider business mailing address

1418 COLLEGE DR
MOUNT CARMEL IL
62863-2638
US

V. Phone/Fax

Practice location:
  • Phone: 618-263-9363
  • Fax:
Mailing address:
  • Phone: 618-262-8621
  • Fax: 618-263-6467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. KARISSA TURNER
Title or Position: CEO
Credential:
Phone: 618-262-8621