=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851200265
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WABASH GENERAL HOSPITAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2026
-----------------------------------------------------
Last Update Date | 09/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11362 COUNTRY CLUB RD
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62439-4325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-707-4360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1418 COLLEGE DR
-----------------------------------------------------
City | MOUNT CARMEL
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62863-2638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-263-6379
-----------------------------------------------------
Fax | 618-263-6467
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KARISSA TURNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 618-262-8621
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------