Organization
DEACONESS CLINIC INC.
Active
Other names
Deaconess Clinic II
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD M STIVERS (CFO)
(812) 450-3296
Entity
Organization
Contact information
Practice address
685 VAIL STREET, PRINCETON, IN 47670-9510
(812) 386-6650
(812) 385-5015
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
213E00000X
Podiatrist
—
—
231H00000X
Audiologist
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200910700
—
IN
01
—
7100051590
KY MEDICAID PHYSICIANS
KY
01
—
7100051610
KY MEDICAID NP
KY
01
—
7100051640
KY MEDICAID PODIATRY
KY
Enumeration date
08/18/2008
Last updated
02/08/2010
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