Organization
DEACONESS HOSPITAL, INC
Active
Organization
DEACONESS HOSPITAL, INC
Active
Other names
Deaconess Medical Group - Specialty
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD M STIVERS (SR VICE PRESIDENT, CFO)
(812) 450-3296
Entity
Organization
Contact information
Practice address
519 HARRIET ST, EVANSVILLE, IN 47710-1715
(812) 423-9699
(812) 434-2025
Mailing address
PO BOX 3407, EVANSVILLE, IN 47733-3407
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65931586
—
KY
01
—
CG1119
RR MCARE GROUP #
IN
Enumeration date
07/27/2006
Last updated
10/19/2007
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