Organization
DEACONESS HOSPITAL, INC
Active
Other names
Deaconess Emergency Physicians - Gateway
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL A WATHEN (CFO)
(812) 450-3296
Entity
Organization
Contact information
Practice address
4011 GATEWAY BLVD, NEWBURGH, IN 47630-8947
(812) 450-3405
(812) 450-3099
Mailing address
PO BOX 3407, EVANSVILLE, IN 47733-3407
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100181080B
—
IN
01
—
CG1119
RR MEDICARE GROUP #
IN
Enumeration date
06/29/2006
Last updated
07/06/2017
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