# DEACONESS MEMORIAL MEDICAL CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DEACONESS MEMORIAL MEDICAL CENTER INC
- **Other names:** PETERSBURG FAMILY MEDICINE
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1689770083
- **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:** 1003 E ILLINOIS ST, PETERSBURG, IN 47567
- **Practice address phone:** (812) 354-3458
- **Practice address fax:** (812) 354-3459
- **Mailing address:** 800 W 9TH ST, JASPER, IN 47546-2514
- **Mailing address phone:** (812) 996-8478

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 09/15/2006
- **Last updated:** 03/16/2026