MEDICARE: DEACONESS CLINIC, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	207K00000X	Allergy & Immunology Physician
3	207Q00000X	Family Medicine Physician
4	207R00000X	Internal Medicine Physician
5	207RP1001X	Pulmonary Disease Physician
6	208000000X	Pediatrics Physician
7	363L00000X	Nurse Practitioner
8	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1528214400
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	:	812-386-6560
Fax Number	:	812-385-5015

Provider Business Practice Location Address
First Line	:	685 VAIL STREET
Second Line	:
City	:	PRINCETON
State	:	IN
Zip	:	47670-9510
Country	:	US
Telephone Number	:	812-386-6560
Fax Number	:	812-385-5015

Authorized Official
Title or Position	:	CFO
Name	:	CHERYL A WATHEN
Credential	:
Telephone Number	:	812-450-3296

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	12/07/2023

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Directions to “DEACONESS CLINIC, INC ” Practice Location

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