Organization
DEACONESS CLINIC, INC
Active
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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