Provider Demographics
NPI:1023233137
Name:DEACONESS WOMEN'S HOSPITAL OF SOUTHERN IN, LLC
Entity type:Organization
Organization Name:DEACONESS WOMEN'S HOSPITAL OF SOUTHERN IN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CADY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:812-842-4263
Mailing Address - Street 1:P.O. BOX 637276
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7276
Mailing Address - Country:US
Mailing Address - Phone:812-842-2820
Mailing Address - Fax:812-842-4226
Practice Address - Street 1:4199 GATEWAY BLVD,
Practice Address - Street 2:SUITE 3800
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8940
Practice Address - Country:US
Practice Address - Phone:812-842-2820
Practice Address - Fax:812-842-4226
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEACONESS WOMEN'S HOSPITAL OF SOUTHERN INDIANA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-16
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11-002855-1225100000X
IN05008176A2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty