Healthcare Provider Details

I. General information

NPI: 1053558841
Provider Name (Legal Business Name): DEACONESS CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 HARRIET ST SUITE L-100
EVANSVILLE IN
47710-1781
US

IV. Provider business mailing address

PO BOX 3868
EVANSVILLE IN
47737-3868
US

V. Phone/Fax

Practice location:
  • Phone: 812-426-9411
  • Fax: 812-426-9503
Mailing address:
  • Phone: 812-426-9411
  • Fax: 812-426-9503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LINDA E WHITE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 812-450-2250