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NPI Code Detail

MEDICARE: DEACONESS CLINIC, INC

MEDICARE: DEACONESS CLINIC, 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
1363A00000XPhysician Assistant
2363L00000XNurse Practitioner
3207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1396040374
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEACONESS CLINIC, INC
Provider Business Mailing Address
First Line : PO BOX 1510
Second Line :
City : EVANSVILLE
State : IN
Zip : 47706-1510
Country : US
Telephone Number : 812-749-6187
Fax Number : 812-749-4966
Provider Business Practice Location Address
First Line : 1204 WILLIAMS ST.
Second Line :
City : OAKLAND CITY
State : IN
Zip : 47660-1001
Country : US
Telephone Number : 812-749-6187
Fax Number : 812-749-4966
Authorized Official
Title or Position : CFO
Name : CHERYL A WATHEN
Credential :
Telephone Number : 812-450-3296
Provider Enumeration Date : 01/21/2011
Last Update Date : 08/10/2017

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Directions to “DEACONESS CLINIC, INC ” Practice Location

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