Provider Demographics
NPI:1346516499
Name:DEACONESS CARE INTEGRATION
Entity Type:Organization
Organization Name:DEACONESS CARE INTEGRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-426-6626
Mailing Address - Street 1:421 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1227
Mailing Address - Country:US
Mailing Address - Phone:812-492-5157
Mailing Address - Fax:812-858-4513
Practice Address - Street 1:421 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1227
Practice Address - Country:US
Practice Address - Phone:812-492-5157
Practice Address - Fax:812-858-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INA1221302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization