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General NPI Number Information
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NPI Number | 1457289787
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Entity Type | Organization
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Legal Business Name | DEACONESS SPECIALITY PHYSICIANS, INC
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Dates
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Enumeration Date | 05/08/2026
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Last Update Date | 05/08/2026
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Provider Practice Location Address
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Address Line | 1004 E ILLINOIS ST
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City | PETERSBURG
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State | IN
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Zip | 47567-8068
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Country | US
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Telephone | 812-354-8280
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Fax |
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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 | 812-450-6815
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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 | 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 | 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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