Healthcare Provider Details

I. General information

NPI: 1790863835
Provider Name (Legal Business Name): DEACONESS MEMORIAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W 13TH ST SUITE 122
JASPER IN
47546-1855
US

IV. Provider business mailing address

PO BOX 1028
JASPER IN
47547-1028
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-0626
  • Fax: 812-482-0650
Mailing address:
  • Phone: 812-481-8483
  • Fax: 812-481-8497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEITH MILLER
Title or Position: CAO & INDIANA REGION PRESIDENT
Credential:
Phone: 812-996-0507