Organization
DEACONESS CLINIC INC.
Active
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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