Organization
VETERAN'S ADMINISTRATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GERALDINE THORNHILL WIRTH A.P.R.N. (NURSE PRACTITIONER)
(217) 875-2670
Entity
Organization
Contact information
Practice address
3035 E MOUND RD, DECATUR, IL 62526-9650
(217) 875-2670
(217) 875-2689
Mailing address
632 E BODMAN ST, BEMENT, IL 61813-1206
(217) 620-8891
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
IL
Other
Enumeration date
08/16/2006
Last updated
08/22/2020
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