Organization
DEACONESS CLINC INC
Active
Other names
Deaconess Clinic Dermatology Madisonville
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL ANNETTE WATHEN (CFO)
(812) 450-3296
Entity
Organization
Contact information
Practice address
1851 N MAIN ST, MADISONVILLE, KY 42431-9024
(812) 450-6859
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
11/12/2021
Last updated
11/12/2021
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