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General NPI Number Information
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NPI Number | 1396040374
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Entity Type | Organization
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Legal Business Name | DEACONESS CLINIC, INC
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 08/10/2017
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Provider Practice Location Address
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Address Line | 1204 WILLIAMS ST.
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City | OAKLAND CITY
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State | IN
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Zip | 47660-1001
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Country | US
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Telephone | 812-749-6187
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Fax | 812-749-4966
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Provider Business Mailing Address
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Address Line | PO BOX 1510
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City | EVANSVILLE
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State | IN
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Zip | 47706-1510
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Country | US
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Telephone | 812-749-6187
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Fax | 812-749-4966
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Authorized Official
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Title or Position | CFO
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Name | CHERYL A 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 | 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 #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 | 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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