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Organization

DEACONESS CLINIC, INC

Active
Other names
Deaconess Clinic I
Organization subpart
No

Provider details

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

Contact information

Practice address
340 STARLITE DR, HENDERSON, KY 42420-6102
(270) 844-8027
(270) 844-8183
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(270) 844-8027
(270) 844-8183

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
207R00000X
Internal Medicine Physician
Primary
207RG0100X
Gastroenterology Physician
207RN0300X
Nephrology Physician
2080P0206X
Pediatric Gastroenterology Physician
363L00000X
Nurse Practitioner
363LA2100X
Acute Care Nurse Practitioner
363LF0000X
Family Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200910700P
IN
05
7100051620
KY
Enumeration date
11/02/2011
Last updated
08/10/2017
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