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General NPI Number Information
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NPI Number | 1235107939
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Entity Type | Organization
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Legal Business Name | DECATUR HEALTHCARE LLC
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1770 E LAKE SHORE DR
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City | DECATUR
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State | IL
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Zip | 62521-3832
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Country | US
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Telephone | 217-424-1021
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Fax | 217-424-1027
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Provider Business Mailing Address
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Address Line | 1770 E LAKE SHORE DR
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City | DECATUR
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State | IL
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Zip | 62521-3832
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Country | US
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Telephone | 217-424-1021
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Fax | 217-424-1027
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Authorized Official
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Title or Position | CEO
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Name | DR. THOMAS J PLIURA
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Credential | MD
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Telephone | 309-962-2299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | IL
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