Provider Demographics
NPI:1114023512
Name:DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC
Entity Type:Organization
Organization Name:DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC
Other - Org Name:THE WOMEN'S HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-842-4200
Mailing Address - Street 1:4199 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8940
Mailing Address - Country:US
Mailing Address - Phone:812-842-4200
Mailing Address - Fax:812-842-4535
Practice Address - Street 1:4199 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8940
Practice Address - Country:US
Practice Address - Phone:812-842-4200
Practice Address - Fax:812-842-4227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06-002855-2282N00000X
IN13-002855-1282N00000X
IN18-002855-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01300185Medicaid
IN200327520AMedicaid
IN150149Medicare Oscar/Certification