Healthcare Provider Details

I. General information

NPI: 1114760501
Provider Name (Legal Business Name): DEACONESS HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S US HIGHWAY 231 STE C
JASPER IN
47546-3244
US

IV. Provider business mailing address

701 GARFIELD AVE
EVANSVILLE IN
47710-1771
US

V. Phone/Fax

Practice location:
  • Phone: 812-996-0620
  • Fax: 812-996-5704
Mailing address:
  • Phone: 812-450-4673
  • Fax: 812-450-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHERYL ANNETTE WATHEN
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 812-450-3296