Organization
DEACONESS WELBORN SURGICAL HOLDING COMPANY, LLC
Active
Other names
Deaconess Procedure Center
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD M STIVERS (SECRETARY/TREASURER)
(812) 450-3296
Entity
Organization
Contact information
Practice address
421 CHESTNUT ST, EVANSVILLE, IN 47713-1227
(812) 426-9412
Mailing address
PO BOX 3868, EVANSVILLE, IN 47737-3868
(812) 426-9506
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200919180
—
IN
Enumeration date
09/09/2008
Last updated
05/21/2009
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