Deaconess Hospital, Inc
Organization Active NPI Rural Health Clinic/Center · Petersburg, IN
NPI 1710098405 · NPPES record last updated Jan 2, 2008
Key facts
- NPI
- 1710098405
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- DEACONESS HOSPITAL, INC
- Practice address
- 106 W Pike Ave
Petersburg, IN 47567-8750 - Phone
- (812) 354-1052
- Fax
- (812) 354-8280
- NPI assigned
- Aug 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Richard M Stivers
- Title
- Sr Vice President, Cfo
- Phone
- (812) 450-3296
Other NPIs on the same Medicare enrollment 43
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040115000129 | IN | Part B Supplier - Clinic/Group Practice | 9032021431 |
Receives reassigned benefits from 719 practitioners 43 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Evansville, IN; Newburgh, IN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
106 W Pike Ave
Petersburg, IN 47567-8750
Mailing address
PO Box 3407
Evansville, IN 47733-3407
Phone (812) 450-6815
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 153843 | Other | IN | RURAL HEALTH # |
| CG1119 | Other | IN | RR MCARE GROUP # |
Other names
- Deaconess Medical Group - Petersburg
Other providers in Petersburg, IN
- Sharon Lynn Cannon
- Alexandria Jo Carie-Kroeger
- CRS Optical PC
- Daviess County Hospital
- Deaconess Clinic, Inc
- Deaconess Memorial Medical Center Inc
- Deaconess Speciality Physicians, Inc
- Gregory Lee Dunigan
- Dycora Transitional Health - Petersburg LLC
- Laryn Faulk
All providers in Petersburg, IN · Rural Health Clinic/Center in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2008. 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.