1639453400 NPI number — DEACONESS HOSPITAL, INC

Table of content: (NPI 1639453400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639453400 NPI number — DEACONESS HOSPITAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEACONESS HOSPITAL, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DEACONESS HOME MEDICAL EQUIPMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639453400
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 GARFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47710-1771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-450-4673
Provider Business Mailing Address Fax Number:
812-450-4665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 W COLUMBIA ST
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47710-1782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-450-3461
Provider Business Practice Location Address Fax Number:
812-450-6739
Provider Enumeration Date:
09/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
812-450-5000

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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