Provider Demographics
NPI:1750336640
Name:DEACONESS HEART CENTER CATH LAB
Entity type:Organization
Organization Name:DEACONESS HEART CENTER CATH LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEPSIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-464-9133
Mailing Address - Street 1:415 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1656
Mailing Address - Country:US
Mailing Address - Phone:812-464-0547
Mailing Address - Fax:812-464-4485
Practice Address - Street 1:415 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1656
Practice Address - Country:US
Practice Address - Phone:812-464-0547
Practice Address - Fax:812-464-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000362389OtherANTHEM
IN222970Medicare ID - Type UnspecifiedIN MCR
INP00190982Medicare ID - Type UnspecifiedIN RR MCR