NPIMap

Deaconess Clinic, Inc

Organization Active NPI Family Medicine Physician · Henderson, KY

NPI 1104445014 · NPPES record last updated Apr 10, 2020

Key facts

NPI
1104445014
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
DEACONESS CLINIC, INC
Practice address
471 Klutey Park Plaza Dr
Henderson, KY 42420-3347
Phone
(270) 830-6100
Fax
(270) 826-3089
NPI assigned
Apr 10, 2020
Organization subpart
No

Authorized official

Name
Cheryl Annette Wathen
Title
Cfo
Phone
(812) 450-3296

Other NPIs on the same Medicare enrollment 28

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 28

Corporate family (same tax ID) 13

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2162097Deaconess Clinic Klutey Park
471 Klutey Park Drive, Henderson, KY 42420		Provider-performed microscopyFeb 14, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in KY

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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

Tax ID family
Deaconess Clinc Inc (99 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363L00000X
Family Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363LF0000X

Addresses

Primary practice location

471 Klutey Park Plaza Dr
Henderson, KY 42420-3347

Mailing address

PO Box 1510
Evansville, IN 47706-1510
Phone (812) 450-6815

Other names

  • Deaconess Clinic Klutey Park Doing business as

Other providers in Henderson, KY

All providers in Henderson, KY · Family Medicine Physician in Kentucky

Sources for this page

Verify at the official NPI Registry.