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Organization

DEACONESS CLINIC INC.

Active
Other names
Deaconess Clinic II
Organization subpart
No

Provider details

NPI number
Authorized official
CHERYL A WATHEN (CFO)
(812) 450-3296
Entity
Organization

Contact information

Practice address
4233 GATEWAY BLVD, NEWBURGH, IN 47630-8900
(812) 426-6638
(812) 450-8109
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(812) 426-6638
(812) 450-8109

Taxonomy

Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
207N00000X
Dermatology Physician
207Q00000X
Family Medicine Physician
Primary
207R00000X
Internal Medicine Physician
207RG0100X
Gastroenterology Physician
207RH0003X
Hematology & Oncology Physician
207RR0500X
Rheumatology Physician
2080P0206X
Pediatric Gastroenterology Physician
2084N0400X
Neurology Physician
2086S0122X
Plastic and Reconstructive Surgery Physician
213E00000X
Podiatrist
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner
363LA2100X
Acute Care Nurse Practitioner
363LF0000X
Family Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200910900
IN
01
7100051640
KY MEDICAID PODIATRY
KY
01
7100302340
KY MEDICAID NURSE PRACTITIONER
KY
01
7100302450
KY MEDICAID PHYSICIANS
KY
01
7100318210
KENTUCKY MEDICAID PHYSICIAN ASSISTANCE
KY
Enumeration date
08/12/2008
Last updated
10/20/2022
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