# DEACONESS CLINIC, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Deaconess Clinic I
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093143216
- **Authorized official:** CHERYL A WATHEN (CFO)
- **Authorized official phone:** (812) 450-3296

## Contact information

- **Practice address:** 6221 PHYSICIANS CT, SUITE 1, EVANSVILLE, IN 47715-4031
- **Practice address phone:** (812) 479-3153
- **Practice address fax:** (812) 473-8166
- **Mailing address:** PO BOX 1510, EVANSVILLE, IN 47706-1510
- **Mailing address phone:** (812) 479-3153
- **Mailing address fax:** (812) 473-8166

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | — | NULL | Yes |
| 207K00000X | Allergy & Immunology Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 10/25/2013
- **Last updated:** 08/10/2017