Provider Demographics
NPI:1588751234
Name:DECATUR MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:DECATUR MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:STONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:217-876-2107
Mailing Address - Street 1:2300 N. EDWARD ST.
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526
Mailing Address - Country:US
Mailing Address - Phone:217-876-8121
Mailing Address - Fax:217-876-2261
Practice Address - Street 1:2870 N MAIN ST
Practice Address - Street 2:DECATUR MEMORIAL HOME CARE
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3234
Practice Address - Country:US
Practice Address - Phone:217-876-4600
Practice Address - Fax:217-876-4660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECATUR MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2000354251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149441OtherHEALTHLINK
IL9698OtherBLUE CROSS
IL9688OtherBLUECROSS
IL=========Medicaid
IL=========004Medicaid