MEDICARE: DEACONESS HOSPITAL, 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
1	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1548787203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEACONESS HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	600 MARY ST
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47710-1674
Country	:	US
Telephone Number	:	812-450-6856
Fax Number	:

Provider Business Practice Location Address
First Line	:	4949 HEALTHY WAY STE B
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-1180
Country	:	US
Telephone Number	:	812-492-5270
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	CHERYL WATHEN
Credential	:
Telephone Number	:	812-450-3356

Provider Enumeration Date	:	08/24/2017
Last Update Date	:	08/24/2017

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