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General NPI Number Information
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NPI Number | 1740360700
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Entity Type | Organization
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Legal Business Name | DEACONESS MEMORIAL MEDICAL CENTER, INC
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 105 COOPER ST
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City | LOOGOOTEE
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State | IN
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Zip | 47553
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Country | US
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Telephone | 812-295-2812
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Fax | 812-295-3726
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Provider Business Mailing Address
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Address Line | 800 W 9TH ST
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City | JASPER
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State | IN
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Zip | 47546-2514
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CAO & INDIANA REGION PRESIDENT
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Name | KEITH MILLER
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Credential |
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Telephone | 812-996-0507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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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 | 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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