Healthcare Provider Details

I. General information

NPI: 1811737299
Provider Name (Legal Business Name): DEACONESS SPECIALTY PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 N CROSS POINTE BLVD STE 320
EVANSVILLE IN
47715-4013
US

IV. Provider business mailing address

PO BOX 632111
CINCINNATI OH
45263-2111
US

V. Phone/Fax

Practice location:
  • Phone: 812-471-4611
  • Fax: 812-471-4643
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHERYL ANNETTE WATHEN
Title or Position: CFO
Credential:
Phone: 812-450-3296