NPIMap

Organization Active NPI

Decatur Memorial Hospital

  • Community/Retail Pharmacy
  • Decatur, IL
National Provider Identifier
1609879097
Registry record updated May 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054011351 Issued in IL
Legal business name
DECATUR MEMORIAL HOSPITAL
Doing business as
PHYSICIAN'S PLAZA PHARMACY
Practice address
2300 N Edward St
Decatur, IL 62526-4163
Phone
(217) 876-6252
Fax
(217) 876-6215
NPI assigned
May 31, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Steven Welch, RPH
Title
Phrmcy MGR
Phone
(217) 876-6252

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 054011351 IL Primary

Addresses

Primary practice location

2300 N Edward St
Decatur, IL 62526-4163

Mailing address

2300 N Edward St
Decatur, IL 62526-4163
Phone (217) 876-6252

Other identifiers 1

IdentifierTypeStateIssuer
2017369OtherPK

Other names 1

  • PHYSICIAN'S PLAZA PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Decatur Memroial Hospit6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369267200000",
    "number": "1609879097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 N EDWARD ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264163",
            "telephone_number": "217-876-6252",
            "fax_number": "217-876-6215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 N EDWARD ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264163",
            "telephone_number": "217-876-6252",
            "fax_number": "217-876-6215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECATUR MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-31",
        "last_updated": "2013-05-23",
        "status": "A",
        "authorized_official_last_name": "WELCH",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "PHRMCY MGR",
        "authorized_official_telephone_number": "217-876-6252",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054011351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2017369",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHYSICIAN'S PLAZA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Decatur, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.