MEDICARE: DEACONESS SPECIALTY PHYSICIANS 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
1	363A00000X	Physician Assistant
2	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1831996222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEACONESS SPECIALTY PHYSICIANS INC

Provider Business Mailing Address
First Line	:	PO BOX 632111
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-2111
Country	:	US
Telephone Number	:	812-450-6879
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 N ELM ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-2768
Country	:	US
Telephone Number	:	270-831-7937
Fax Number	:	270-831-7939

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

Provider Enumeration Date	:	02/25/2025
Last Update Date	:	03/25/2026

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