Provider Demographics
NPI:1598860819
Name:DEACONESS HOSPITAL, INC
Entity Type:Organization
Organization Name:DEACONESS HOSPITAL, INC
Other - Org Name:DEACONESS OAK HILL PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WATHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-450-3296
Mailing Address - Street 1:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-424-4602
Mailing Address - Fax:812-421-5147
Practice Address - Street 1:1750 OAK HILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-4364
Practice Address - Country:US
Practice Address - Phone:812-424-4602
Practice Address - Fax:812-421-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCG1119OtherRR MCARE GROUP #
INCG1119Medicare PIN
IN849950Medicare PIN