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General NPI Number Information
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NPI Number | 1003612946
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Entity Type | Organization
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Legal Business Name | DEACONESS SPECIALTY PHYSICIANS INC
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 736 N ELM ST
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City | HENDERSON
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State | KY
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Zip | 42420-2938
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Country | US
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Telephone | 270-827-7199
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Fax | 270-827-7376
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Provider Business Mailing Address
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Address Line | PO BOX 632111
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City | CINCINNATI
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State | OH
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Zip | 45263-2111
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Country | US
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Telephone | 812-450-6879
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | CHERYL ANNETTE WATHEN
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Credential |
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Telephone | 812-450-3296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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