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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
1207R00000XInternal Medicine Physician
2208000000XPediatrics Physician
3363A00000XPhysician Assistant
4363L00000XNurse Practitioner
5363LF0000XFamily Nurse Practitioner
6207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1639502859
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 : 812-450-6879
Fax Number : 812-858-4586
Provider Business Practice Location Address
First Line : 3150 WARRICK DR
Second Line :
City : BOONVILLE
State : IN
Zip : 47601-8602
Country : US
Telephone Number : 812-858-3355
Fax Number : 812-858-3350
Authorized Official
Title or Position : CFO
Name : CHERYL A WATHEN
Credential :
Telephone Number : 812-450-3296
Provider Enumeration Date : 08/12/2013
Last Update Date : 10/27/2020

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Directions to “DEACONESS CLINIC, INC ” Practice Location

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