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1700029311 NPI number — DEACONESS MEMORIAL MEDICAL CENTER INC

NPI Number: 1700029311
Health Care Provider/Practitioner: DEACONESS MEMORIAL MEDICAL CENTER INC

Information about “1700029311” NPI (DEACONESS MEMORIAL MEDICAL CENTER INC) exists in 1700029311 in HTML format HTML  |  1700029311 in plain Text format TXT  |  1700029311 in PDF (Portable Document Format) PDF  |  1700029311 in an XML format XML  formats.

NPI Number : 1700029311 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700029311",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "DEACONESS MEMORIAL MEDICAL CENTER INC",
    "ParentOrgTIN": null,
    "OrgName": "DEACONESS MEMORIAL MEDICAL CENTER INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 1028",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JASPER",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "47547-1028",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "812-481-8493",
    "MailingAddressFaxNumber": "812-481-8497",
    "FirstLinePracticeLocationAddress": "407 E 22ND ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HUNTINGBURG",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "47542-8964",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "812-683-3612",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/13/2009",
    "LastUpdateDate": "08/27/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MILLER",
    "AuthorizedOfficialFirstName": "KEITH",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CAO & INDIANA REGION PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "812-996-0507",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2084N0400X",
        "TaxonomyName": "Neurology Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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