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	207Q00000X	Family Medicine Physician
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician
3	207R00000X	Internal Medicine Physician
4	363L00000X	Nurse Practitioner
5	207RG0300X	Geriatric Medicine (Internal 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
2	CG1119	OTHER	IN	RR MCARE GROUP #

General Provider Information

NPI Number	:	1447264759
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	:	812-450-6815
Fax Number	:	812-450-6822

Provider Business Practice Location Address
First Line	:	1750 OAK HILL RD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47711-4364
Country	:	US
Telephone Number	:	812-485-2580
Fax Number	:	812-450-2590

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	07/03/2017

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Directions to “DEACONESS HOSPITAL, INC ” Practice Location

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