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NPI Code Detail

MEDICARE: DEACONESS CLINIC INC

MEDICARE: DEACONESS CLINIC INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner
2207R00000XInternal Medicine Physician
31041C0700XClinical Social Worker
4207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1093000283
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEACONESS CLINIC INC
Provider Business Mailing Address
First Line : PO BOX 1510
Second Line :
City : EVANSVILLE
State : IN
Zip : 47706-1510
Country : US
Telephone Number : 812-465-1250
Fax Number : 812-465-7170
Provider Business Practice Location Address
First Line : 8600 UNIVERSITY BLVD
Second Line : ROOM HP0091
City : EVANSVILLE
State : IN
Zip : 47712-3534
Country : US
Telephone Number : 812-465-1250
Fax Number : 812-465-7170
Authorized Official
Title or Position : CFO
Name : CHERYL A WATHEN
Credential :
Telephone Number : 812-450-3296
Provider Enumeration Date : 06/15/2011
Last Update Date : 08/10/2017

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Practice Location Address:
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1891797007 — RICHARD A RIEDFORD M.D.
Practice Location Address:
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1336152156 — DEACONESS HOSPITAL, INC
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8600 UNIVERSITY BLVD , RM HP0091
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1508932930 — VERNON PAUL BANNING MD
Practice Location Address:
8600 UNIVERSITY BLVD , RM HP0091
EVANSVILLE, IN
47712-3534
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1609934769 — PHILIP A WUERTZ LCSW
Practice Location Address:
8600 UNIVERSITY BLVD , RM HP0091
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1013200930 — MELISSA L ATTEBURY NP
Practice Location Address:
8600 UNIVERSITY BLVD RM HP0091
EVANSVILLE, IN
47712-3534
Practice Phone: 812-465-1250
Practice Fax: 812-465-7170

Directions to “DEACONESS CLINIC INC ” Practice Location

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