=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639860778
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEACONESS HOSPITAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2023
-----------------------------------------------------
Last Update Date | 05/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 617 OAKLEY ST
-----------------------------------------------------
City | EVANSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47710-1647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-450-6338
-----------------------------------------------------
Fax | 812-858-4530
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 MARY ST
-----------------------------------------------------
City | EVANSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47710-1658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-450-3784
-----------------------------------------------------
Fax | 812-858-4530
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | THOMAS FITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 812-450-3784
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------