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General NPI Number Information
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NPI Number | 1104452200
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Entity Type | Organization
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Legal Business Name | DEACONESS MEMORIAL MEDICAL CENTER INC
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 695 W 2ND ST STE D
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City | JASPER
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State | IN
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Zip | 47546-3240
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Country | US
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Telephone | 812-996-6330
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Fax | 812-996-6331
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Provider Business Mailing Address
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Address Line | 800 W 9TH ST
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City | JASPER
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State | IN
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Zip | 47546-2514
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Country | US
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Telephone | 812-996-8478
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Fax | 812-996-8497
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Authorized Official
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Title or Position | CAO & INDIANA REGION PRESIDENT
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Name | KEITH MILLER
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Credential |
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Telephone | 812-996-0507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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