Provider Demographics
NPI:1114315181
Name:DEACONESS HOSPITAL, INC.
Entity Type:Organization
Organization Name:DEACONESS HOSPITAL, INC.
Other - Org Name:DEACONESS HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-450-2250
Mailing Address - Street 1:600 MARY ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1674
Mailing Address - Country:US
Mailing Address - Phone:812-450-4673
Mailing Address - Fax:812-450-4665
Practice Address - Street 1:3150 WARRICK DR STE 100
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-8602
Practice Address - Country:US
Practice Address - Phone:812-897-5660
Practice Address - Fax:812-897-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies