MEDICARE: THE DEACONESS HEALTH ASSOCIATIONS FUND, 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1972916625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DEACONESS HEALTH ASSOCIATIONS FUND, INC.

Provider Business Mailing Address
First Line	:	615 ELSINORE PL STE 900
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-1434
Country	:	US
Telephone Number	:	513-559-2854
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 ELSINORE PL STE 900
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-1434
Country	:	US
Telephone Number	:	513-559-2854
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	HEIDEE FRIESTUHLER
Credential	:
Telephone Number	:	513-559-2854

Provider Enumeration Date	:	06/10/2014
Last Update Date	:	01/31/2019

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Directions to “THE DEACONESS HEALTH ASSOCIATIONS FUND, INC. ” Practice Location

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