Organization
DEACONESS HOSPITAL, INC
Active
Other names
Deaconess Primary Care for Seniors - North
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL A WATHEN (CFO)
(812) 450-3296
Entity
Organization
Contact information
Practice address
4498 N 1ST AVE, EVANSVILLE, IN 47710-3622
(812) 436-7280
(812) 436-7290
Mailing address
PO BOX 3407, EVANSVILLE, IN 47733-3407
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200180960A
—
IN
01
—
CG1119
RR MCARE GROUP #
IN
Enumeration date
08/03/2006
Last updated
07/03/2017
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