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General NPI Number Information
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NPI Number | 1861420689
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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 | 06/29/2006
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 721 W 13TH ST SUITE 101
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City | JASPER
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State | IN
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Zip | 47546-1855
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Country | US
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Telephone | 812-481-5780
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Fax |
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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 | MR. 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 | 103T00000X
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Taxonomy Name | Psychologist
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry 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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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