# DEACONESS HOSPITAL, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Deaconess Medical Group - Ft Branch
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306957097
- **Authorized official:** RICHARD M STIVERS (SR VICE PRESIDENT, CFO)
- **Authorized official phone:** (812) 450-3296

## Contact information

- **Practice address:** 802 E OAK ST, FORT BRANCH, IN 47648-1666
- **Practice address phone:** (812) 753-3942
- **Practice address fax:** (812) 768-6283
- **Mailing address:** PO BOX 3407, EVANSVILLE, IN 47733-3407
- **Mailing address phone:** (812) 450-6815
- **Mailing address fax:** (812) 450-6822

## Taxonomy

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

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 10/19/2007