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NPI Code Detail

MEDICARE: DEACONESS MEMORIAL MEDICAL CENTER INC

MEDICARE: DEACONESS MEMORIAL MEDICAL CENTER INC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1306323597
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEACONESS MEMORIAL MEDICAL CENTER INC
Provider Business Mailing Address
First Line : 800 W 9TH ST
Second Line :
City : JASPER
State : IN
Zip : 47546-2514
Country : US
Telephone Number : 812-996-8478
Fax Number :
Provider Business Practice Location Address
First Line : 966 BARTLEY STREET
Second Line :
City : JASPER
State : IN
Zip : 47546-2641
Country : US
Telephone Number : 812-996-7810
Fax Number : 812-996-8465
Authorized Official
Title or Position : CAO & INDIANA REGION PRESIDENT
Name : KEITH MILLER
Credential :
Telephone Number : 812-996-0507
Provider Enumeration Date : 07/20/2018
Last Update Date : 08/27/2025

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Directions to “DEACONESS MEMORIAL MEDICAL CENTER INC ” Practice Location

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