=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598378978
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEACONESS HEALTH KENTUCKY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2020
-----------------------------------------------------
Last Update Date | 09/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4604 US HIGHWAY 60 W
-----------------------------------------------------
City | MORGANFIELD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42437-6515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-826-6558
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 MARY ST
-----------------------------------------------------
City | EVANSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47710-1658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-450-3296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | CHERYL WATHEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 812-450-3296
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------