MEDICARE: DEACONESS HOSPITAL, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	208VP0014X	Interventional Pain Medicine Physician
2	363L00000X	Nurse Practitioner
3	363LF0000X	Family Nurse Practitioner
4	207LP2900X	Pain Medicine (Anesthesiology) Physician
5	1041C0700X	Clinical Social Worker
6	208VP0000X	Pain Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013222322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEACONESS HOSPITAL, INC

Provider Business Mailing Address
First Line	:	PO BOX 3407
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47733-3407
Country	:	US
Telephone Number	:	812-450-4800
Fax Number	:	812-450-4855

Provider Business Practice Location Address
First Line	:	4600 W LLOYD EXPY
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47712-6517
Country	:	US
Telephone Number	:	812-450-7246
Fax Number	:	812-450-4855

Authorized Official
Title or Position	:	CFO
Name	:	CHERYL A WATHEN
Credential	:
Telephone Number	:	812-450-3296

Provider Enumeration Date	:	08/11/2010
Last Update Date	:	07/28/2022

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Directions to “DEACONESS HOSPITAL, INC ” Practice Location

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