Provider Demographics
NPI:1366481277
Name:DEACONESS HOSPITAL INC
Entity Type:Organization
Organization Name:DEACONESS HOSPITAL INC
Other - Org Name:DEACONESS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-450-2252
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47701-0001
Mailing Address - Country:US
Mailing Address - Phone:812-450-5000
Mailing Address - Fax:
Practice Address - Street 1:701 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1771
Practice Address - Country:US
Practice Address - Phone:812-450-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEACONESS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-06
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN005074251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN157132Medicare ID - Type UnspecifiedMEDICARE