DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC

Provider Demographics

• NPI: 1114297801
• 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 PROVIDER SERVICES
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: CHIEF EXECUTIVE OFFICER
• Authorized Official - First Name: CHRISTINA
• Authorized Official - Last Name: RYAN
• Authorized Official - Phone: 812-842-4222
• Mailing Address - Street 1: 4199 GATEWAY BLVD
• 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: 812-842-4227
• Practice Address - Street 1: 4199 GATEWAY BLVD
• 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
• Enumeration Date: 2012-01-11
• Last Update Date: 2022-07-08

Provider Licenses

State	License ID	Taxonomies
		103T00000X, 1041C0700X, 207VF0040X, 363LF0000X, 363LN0000X, 363LN0005X, 363LW0102X, 364S00000X
IN	74000008A	170300000X
IN	130028551	207V00000X, 207VX0201X, 363L00000X
IN	01067142A	208200000X
IN	05002666A	225100000X
IN	140028551	363A00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207VX0201X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Gynecologic Oncology	Group - Multi-Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Multi-Specialty
No	170300000X	Other Service Providers	Genetic Counselor, MS		Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	207VF0040X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Female Pelvic Medicine and Reconstructive Surgery	Group - Multi-Specialty
No	208200000X	Allopathic & Osteopathic Physicians	Plastic Surgery		Group - Multi-Specialty
No	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	363LN0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Neonatal	Group - Multi-Specialty
No	363LN0005X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Neonatal, Critical Care	Group - Multi-Specialty
No	363LW0102X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Women's Health	Group - Multi-Specialty
No	364S00000X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IN	200871730	Medicaid
IN	201046630A	Medicaid
IN	201380400	Medicaid
IN	201003930	Medicaid
IN	201044710	Medicaid
IN	201046630B	Medicaid
IN	200931070	Medicaid
IN	200934360	Medicaid
IN	200950810	Medicaid
IN	201386290A	Medicaid
IN	100319460	Medicaid
IN	201003570	Medicaid
IN	201118520	Medicaid
IN	200245730	Medicaid
IN	200951280	Medicaid
IN	201395600A	Medicaid