Healthcare Provider Details

I. General information

NPI: 1174660526
Provider Name (Legal Business Name): DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 GATEWAY BLVD
NEWBURGH IN
47630-8940
US

IV. Provider business mailing address

PO BOX 637273
CINCINNATI OH
45263-7273
US

V. Phone/Fax

Practice location:
  • Phone: 812-842-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA M RYAN
Title or Position: CEO
Credential:
Phone: 812-842-4200