MEDICARE: DECATUR MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1275216095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DECATUR MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 3428
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62708-3428
Country	:	US
Telephone Number	:	800-577-5368
Fax Number	:	217-757-2021

Provider Business Practice Location Address
First Line	:	1220 W JACKSON ST
Second Line	:
City	:	SULLIVAN
State	:	IL
Zip	:	61951-1032
Country	:	US
Telephone Number	:	217-728-2042
Fax Number	:	217-728-2485

Authorized Official
Title or Position	:	DIRECTOR PHYSICIAN BILLING
Name	:	ANN BOWLING
Credential	:
Telephone Number	:	217-588-2626

Provider Enumeration Date	:	08/09/2023
Last Update Date	:	08/09/2023

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Directions to “DECATUR MEMORIAL HOSPITAL ” Practice Location

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