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General NPI Number Information
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NPI Number | 1497632558
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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 | 08/20/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 4604 US HIGHWAY 60 W
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City | MORGANFIELD
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State | KY
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Zip | 42437-6515
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Country | US
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Telephone | 270-389-5130
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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 | 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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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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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 | 208VP0000X
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Taxonomy Name | Pain Medicine 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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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