DEACONESS CLINIC, INC

Provider Demographics

• NPI: 1952920852
• Name: DEACONESS CLINIC, INC
• Entity Type: Organization
• Organization Name: DEACONESS CLINIC, INC
• Other - Org Name: DEACONESS CLINIC ATKINSON
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: CFO
• Authorized Official - First Name: CHERYL
• Authorized Official - Middle Name: ANNETTE
• Authorized Official - Last Name: WATHEN
• Authorized Official - Phone: 812-450-3296
• Mailing Address - Street 1: PO BOX 1510
• Mailing Address - City: EVANSVILLE
• Mailing Address - State: IN
• Mailing Address - Zip Code: 47706-1510
• Mailing Address - Country: US
• Mailing Address - Phone: 124-506-8158
• Mailing Address - Fax: 812-450-6822
• Practice Address - Street 1: 1413 N ELM ST STE 201
• Practice Address - City: HENDERSON
• Practice Address - State: KY
• Practice Address - Zip Code: 42420-2767
• Practice Address - Country: US
• Practice Address - Phone: 270-827-8662
• Practice Address - Fax: 270-826-8220
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2020-04-10
• Last Update Date: 2020-12-16

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363AM0700X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Medical	Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	363LA2100X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Acute Care	Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	363LP0200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Pediatrics	Group - Multi-Specialty