Deaconess Clinic, Inc
Organization Active NPI Pediatrics Physician · Princeton, IN
NPI 1790397206 · NPPES record last updated Aug 18, 2020
Key facts
- NPI
- 1790397206
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- DEACONESS CLINIC, INC
- Practice address
- 312 3Rd Ave
Princeton, IN 47670-1014 - Phone
- (812) 386-6776
- Fax
- (812) 386-6405
- NPI assigned
- Aug 18, 2020
- Organization subpart
- No
Authorized official
- Name
- Cheryl Annette Wathen
- Title
- Cfo
- Phone
- (812) 450-3296
Corporate family (same tax ID) 24
Practitioners 3
-
Brittney Aryn Stone, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080922000145 | IN | Part B Supplier - Clinic/Group Practice | 3375610116 |
Receives reassigned benefits from 477 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Deaconess Clinc Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes | ||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
312 3Rd Ave
Princeton, IN 47670-1014
Mailing address
PO Box 1510
Evansville, IN 47706-1510
Phone (812) 386-6776
Other names
- Deaconess Clinic - Pediatrics Princeton
Other providers in Princeton, IN
- 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 Hospital, Inc
- Deaconess Hospital, Inc
All providers in Princeton, IN · Pediatrics Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2020. 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.