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General NPI Number Information
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NPI Number | 1255786489
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Entity Type | Organization
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Legal Business Name | DEACONESS REGIONAL HEALTHCARE SERVICES ILLINOIS INC
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Dates
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Enumeration Date | 04/25/2016
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 12 DR. WARREN TUTTLE DRIVE
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City | HARRISBURG
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State | IL
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Zip | 62946
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Country | US
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Telephone | 270-826-6558
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Fax | 270-826-6362
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Provider Business Mailing Address
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Address Line | 600 MARY ST
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City | EVANSVILLE
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State | IN
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Zip | 47710-1658
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Country | US
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Telephone | 618-252-9282
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Fax | 580-628-2267
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARC J FLORENCE
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Credential |
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Telephone | 812-450-2552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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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 | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 5235
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License Number State | IL
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