Healthcare Provider Details

I. General information

NPI: 1659441483
Provider Name (Legal Business Name): DEACONESS HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GARFIELD AVE
EVANSVILLE IN
47710-1771
US

IV. Provider business mailing address

600 MARY ST
EVANSVILLE IN
47747-0001
US

V. Phone/Fax

Practice location:
  • Phone: 812-450-4673
  • Fax: 812-450-4665
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 Number69000101A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number60001691A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number69000101A
License Number StateIN

VIII. Authorized Official

Name: STEPHEN E. CAMP
Title or Position: MANAGER
Credential:
Phone: 812-450-6148