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Organization
DEACONESS CLINC INC
Active
Organization
DEACONESS CLINC INC
Active
Other names
Deaconess Clinic I
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL A WATHEN (CFO)
(812) 450-3296
Entity
Organization
Contact information
Practice address
813 E 4TH ST STE A, MOUNT VERNON, IN 47620-2012
(812) 838-2139
(812) 838-9214
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(812) 838-2139
(812) 838-9214
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200910700
—
IN
Enumeration date
02/11/2010
Last updated
10/27/2020
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