# DEACONESS CLINC INC

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

## Provider details

- **NPI number:** 1609108976
- **Authorized official:** CHERYL A WATHEN (CFO)
- **Authorized official phone:** (812) 450-3296

## Contact information

- **Practice address:** 813 E 4TH ST STE A, MOUNT VERNON, IN 47620-2012
- **Practice address phone:** (812) 838-2139
- **Practice address fax:** (812) 838-9214
- **Mailing address:** PO BOX 1510, EVANSVILLE, IN 47706-1510
- **Mailing address phone:** (812) 838-2139
- **Mailing address fax:** (812) 838-9214

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/11/2010
- **Last updated:** 10/27/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200910700 | — | IN |