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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
421 CHESTNUT ST, EVANSVILLE, IN 47713
(812) 426-9506
(812) 434-7942
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(812) 426-9506
(812) 434-7942

Taxonomy

Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
207R00000X
Internal Medicine Physician
Primary
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
207RG0100X
Gastroenterology Physician
207RH0003X
Hematology & Oncology Physician
207RI0200X
Infectious Disease Physician
207RN0300X
Nephrology Physician
207RR0500X
Rheumatology Physician
2080P0206X
Pediatric Gastroenterology Physician
213E00000X
Podiatrist
231H00000X
Audiologist
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
7100051590
KY MEDICAID PHYSICIAN
KY
01
7100051610
KY MEDICAID NP
KY
01
7100051640
KY MEDICAID PODIATRY
KY
Enumeration date
08/12/2008
Last updated
09/23/2020
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