Organization
DEACONESS CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL A WATHEN (CFO)
(812) 450-3296
Entity
Organization
Contact information
Practice address
8600 N KENTUCKY AVE, EVANSVILLE, IN 47725-6302
(812) 426-9565
(812) 426-9572
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(812) 426-9565
(812) 426-9572
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200910900
—
IN
01
—
7100051590
KY MEDICAID PHYSICIAN
KY
01
—
7100051610
KY MEDICAID NP
KY
01
—
7100051640
KY MEDICAID PODIATRY
KY
Enumeration date
08/18/2008
Last updated
10/27/2020
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