Deaconess Clinic, Inc
Organization Active NPI Pediatrics Physician · Henderson, KY
NPI 1003159997 · NPPES record last updated Aug 10, 2017
Key facts
- NPI
- 1003159997
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- DEACONESS CLINIC, INC
- Practice address
- 1035 N Elm St
Henderson, KY 42420-2712 - Phone
- (270) 827-4596
- Fax
- (270) 826-2838
- NPI assigned
- Mar 29, 2013
- Organization subpart
- No
Authorized official
- Name
- Cheryl A Wathen
- Title
- Cfo
- Phone
- (812) 450-3296
Other NPIs on the same Medicare enrollment 28
Practitioners 7
-
Sheryl Lynn Shelton, ARNP-BC
-
Hisham Allababidi, M.D.
-
Donna J Duncan, NP
-
Nripesh Pradhan, M.D.
-
Tabitha A Shults, NP
-
Amy S Stott, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081017000259 | KY | Part B Supplier - Clinic/Group Practice | 3375610116 |
Receives reassigned benefits from 190 practitioners 28 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Sebree, KY; Philpot, KY; Owensboro, KY; Morganfield, KY; Madisonville, KY; Henderson, KY; Dixon, KY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes | ||
| Pediatric Nurse Practitioner |
363LP0200X |
Addresses
Primary practice location
1035 N Elm St
Henderson, KY 42420-2712
Mailing address
PO Box 1510
Evansville, IN 47706-1510
Phone (270) 827-4596
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100051620 | Medicaid | KY |
Other names
- Deaconess Clinic I
Other providers in Henderson, KY
- Deaconess Clinic Inc
- Deaconess Clinic Inc
- Deaconess Clinic Inc
- Deaconess Clinic Inc
- Deaconess Clinic Inc
- Deaconess Clinic, Inc
- Deaconess Clinic, Inc
- Deaconess Clinic, Inc
- Deaconess Clinic, Inc
- Deaconess Clinic, Inc
All providers in Henderson, KY · Pediatrics Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.