Healthcare Provider Details

I. General information

NPI: 1205864287
Provider Name (Legal Business Name): DEACONESS HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 GATEWAY BLVD
NEWBURGH IN
47630-8954
US

IV. Provider business mailing address

PO BOX 3407
EVANSVILLE IN
47733-3407
US

V. Phone/Fax

Practice location:
  • Phone: 812-853-5300
  • Fax: 812-858-4656
Mailing address:
  • Phone: 812-450-6815
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD M STIVERS
Title or Position: SR VICE PRESIDENT, CFO
Credential:
Phone: 812-450-3296