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	207R00000X	Internal Medicine Physician
2	363L00000X	Nurse Practitioner
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1912175803
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	:	1413 N ELM ST
Second Line	:	STE 106
City	:	HENDERSON
State	:	KY
Zip	:	42420-2768
Country	:	US
Telephone Number	:	270-827-0064
Fax Number	:	270-826-3338

Authorized Official
Title or Position	:	SR VICE PRESIDENT, CFO
Name	:	RICHARD M STIVERS
Credential	:
Telephone Number	:	812-450-3296

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	02/14/2008

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Directions to “DEACONESS HOSPITAL, INC ” Practice Location

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