Organization
WABASH MEMORIAL HOSPITAL ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VENITA EDWARDS-TALLEY M.D. (CLINIC PHYSICIAN)
(217) 425-9642
Entity
Organization
Contact information
Practice address
1501 N WATER ST, DECATUR, IL 62526-4441
(217) 425-9642
(217) 542-0134
Mailing address
1501 N WATER ST, PO BOX 1340, DECATUR, IL 62526-4441
(217) 425-9642
(217) 542-0134
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
36117078
IL
Other
Enumeration date
01/17/2007
Last updated
05/01/2008
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