Provider Demographics
NPI:1912366501
Name:DEACONESS CLINIC
Entity Type:Organization
Organization Name:DEACONESS CLINIC
Other - Org Name:DEACONESS CLINIC COMP CENTER HENDERSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-450-2250
Mailing Address - Street 1:329 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1757
Mailing Address - Country:US
Mailing Address - Phone:812-450-2958
Mailing Address - Fax:812-450-2965
Practice Address - Street 1:340 STARLITE DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-6102
Practice Address - Country:US
Practice Address - Phone:270-844-8515
Practice Address - Fax:270-844-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine