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General NPI Number Information
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NPI Number | 1598094153
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Entity Type | Organization
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Legal Business Name | DECATUR MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 2300 N EDWARD ST GSBLL
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City | DECATUR
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State | IL
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Zip | 62526-4163
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Country | US
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Telephone | 217-876-2857
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Fax | 217-876-2874
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Provider Business Mailing Address
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Address Line | 2300 N EDWARD ST GSBLL
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City | DECATUR
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State | IL
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Zip | 62526-4163
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Country | US
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Telephone | 217-876-2857
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Fax | 217-876-2874
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Authorized Official
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Title or Position | CEO
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Name | JOHN W RIDLEY
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Credential |
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Telephone | 217-876-2857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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