Healthcare Provider Details

I. General information

NPI: 1528456522
Provider Name (Legal Business Name): DEACONESS HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 N GREEN RIVER RD
EVANSVILLE IN
47715-1909
US

IV. Provider business mailing address

600 MARY ST
EVANSVILLE IN
47710-1674
US

V. Phone/Fax

Practice location:
  • Phone: 812-471-0351
  • Fax: 812-471-0379
Mailing address:
  • Phone: 812-450-4673
  • Fax: 812-450-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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