Provider Demographics
NPI:1306011796
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:TRI STATE PERINATOLOGY AT THE WOMEN'S HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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:PO BOX 637273
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7273
Mailing Address - Country:US
Mailing Address - Phone:812-842-4260
Mailing Address - Fax:812-602-3174
Practice Address - Street 1:4199 GATEWAY BLVD STE 3100
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-7906
Practice Address - Country:US
Practice Address - Phone:812-842-4550
Practice Address - Fax:812-842-4549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEACONESS WOMEN'S HOSPITAL OF SOUTHERN IN, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-25
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No170300000XOther Service ProvidersGenetic Counselor, MSGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No364SP1700XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerinatalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200921280AMedicaid
IN200921280AMedicaid