Deaconess Clinic Inc
Organization Active NPI Allergy & Immunology Physician · Owensboro, KY
NPI 1699467720 · NPPES record last updated May 25, 2023
Key facts
- NPI
- 1699467720
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Allergy & Immunology Physician 207K00000X
- Legal business name
- DEACONESS CLINIC INC
- Practice address
- 2851 New Hartford Rd
Owensboro, KY 42303-1320 - Phone
- (812) 479-3153
- Fax
- (812) 858-4546
- NPI assigned
- May 25, 2023
- Organization subpart
- No
Authorized official
- Name
- Cheryl Annette Wathen
- Title
- Cfo
- Phone
- (812) 450-3296
Other NPIs on the same Medicare enrollment 28
Corporate family (same tax ID) 24
Practitioners 6
-
Morgan Elizabeth Lee, PA-C
-
Wendy Jo Lucas, APRN
-
Faryaal Aamir, MD
-
Kelly Shawn Brauer, M.D.
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
- Tax ID family
- Deaconess Clinc Inc
Locations
2200 E Parrish Ave
Ste 202C
Owensboro, KY 42303
Phone (270) 683-7447
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician |
207K00000X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
2851 New Hartford Rd
Owensboro, KY 42303-1320
Mailing address
PO Box 631767
Cincinnati, OH 45263-1767
Other providers in Owensboro, KY
- Christopher S Dawson
- Dudley E. Scott Day
- Katherine Demko Day
- Mary Chiranka De Croos
- Deaconess Clinic Inc
- Deaconess Clinic, Inc.
- Deaconess Clinic, Inc.
- Deaconess Clinic, Inc.
- Deaconess Cross Pointe Center, LLC
- Deaconess Hospital Inc
All providers in Owensboro, KY · Allergy & Immunology 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 May 25, 2023. 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.