Healthcare Provider Details

I. General information

NPI: 1912366501
Provider Name (Legal Business Name): DEACONESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 STARLITE DR
HENDERSON KY
42420-6102
US

IV. Provider business mailing address

329 W COLUMBIA ST
EVANSVILLE IN
47710-1757
US

V. Phone/Fax

Practice location:
  • Phone: 270-844-8515
  • Fax: 270-844-8183
Mailing address:
  • Phone: 812-450-2958
  • Fax: 812-450-2965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA E WHITE
Title or Position: PRESIDENT & CEO
Credential:
Phone: 812-450-2250