Organization
DEACONESS CLINIC INC.
Active
Other names
Deaconess Clinic II
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL A WATHEN (CFO)
(812) 450-3296
Entity
Organization
Contact information
Practice address
3434 W STATE ROAD 66, ROCKPORT, IN 47635-9259
(812) 649-5061
(812) 649-5224
Mailing address
PO BOX 3868, EVANSVILLE, IN 47737-3868
(812) 649-5061
(812) 649-5224
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200910900
—
IN
01
—
7100051590
KY MEDICAID PHYSICIANS
KY
01
—
7100051610
KY MEDICAID NP
KY
01
—
7100051640
KY MEDICAID PODIATRY
KY
Enumeration date
08/12/2008
Last updated
08/10/2017
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