# WABASH MEMORIAL HOSPITAL ASSOCIATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497807689
- **Authorized official:** DR. VENITA EDWARDS-TALLEY M.D. (CLINIC PHYSICIAN)
- **Authorized official phone:** (217) 425-9642

## Contact information

- **Practice address:** 1501 N WATER ST, DECATUR, IL 62526-4441
- **Practice address phone:** (217) 425-9642
- **Practice address fax:** (217) 542-0134
- **Mailing address:** 1501 N WATER ST, PO BOX 1340, DECATUR, IL 62526-4441
- **Mailing address phone:** (217) 425-9642
- **Mailing address fax:** (217) 542-0134

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 36117078 | IL | Yes |

## Other

- **Enumeration date:** 01/17/2007
- **Last updated:** 05/01/2008