# DEACONESS MEMORIAL MEDICAL CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DEACONESS MEMORIAL MEDICAL CENTER INC
- **Other names:** Country Health Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1730420829
- **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:** 5066 N 900 E, MONTGOMERY, IN 47558-5790
- **Practice address phone:** (812) 486-3396
- **Practice address fax:** (812) 486-3354
- **Mailing address:** PO BOX 1028, JASPER, IN 47547-1028
- **Mailing address phone:** (812) 996-8478
- **Mailing address fax:** (812) 996-8497

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 261QR1300X | Rural Health Clinic/Center | — | IN | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/14/2013
- **Last updated:** 03/16/2026