# DEACONESS MEMORIAL MEDICAL CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DEACONESS MEMORIAL MEDICAL CENTER INC
- **Other names:** Alternative Screening Site
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1104452200
- **Legal business name:** DEACONESS MEMORIAL MEDICAL CENTER INC
- **Authorized official:** KEITH MILLER (CAO & INDIANA REGION PRESIDENT)
- **Authorized official phone:** (812) 996-0507

## Contact information

- **Practice address:** 695 W 2ND ST STE D, JASPER, IN 47546-3240
- **Practice address phone:** (812) 996-6330
- **Practice address fax:** (812) 996-6331
- **Mailing address:** 800 W 9TH ST, JASPER, IN 47546-2514
- **Mailing address phone:** (812) 996-8478
- **Mailing address fax:** (812) 996-8497

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/20/2020
- **Last updated:** 08/27/2025